Red Spot Research Articles

Laryngeal carcinoma with hemorraghic varicella : a rare case report

Background : Hemorrhagic varicella is a complication that usually occurs in patients with immune disorders or those on immunosuppressive therapy or hematologic malignancies such as leukemia. Purpose: This case report aimed to further examine the complications of a rarely found hemorrhagic varicella in neck head malignancies / laryngeal carcioma. Case report : This is a case report of laryngeal carcinoma with hemorrhagic varicella in a 44-year-old man. Examination of dermatological status revealed hemorrhagic, polymorphic vesicles, generalized pustular psoriasis, erosion and, crusting. Tzanck test of the scrapes of the base of lesion of the vesicles is helpful in establishing the diagnosis of varicella and discovered multinucleated giant cells (MGCs) and epithelial cells with acidophilic intranuclear inclusion bodies The patient died after 3 days of treatment in the isolation room. A previous study also reported cases of hemorrhagic varicella in a 3-year-old girl with the main complaint of pus-filled red spots throughout the body. A previous history of chickenpox was denied. The physical examination showed dark red, polymorphic lession, generalized pustular psoriasis, erosion and crusting. Hemorrhagic varicella in the head and neck malignancy is a very rare form of varicella. Clinical question: In patient with immunocompromised during chemotheraphy suffer from varicella, is it necessary to have a comprehensive diagnostic examination panel, and therapy? Review methods: Evidence-based literature search with keywords “immunocompromised” AND “Hemorrhagic varicella” was performed through Cochrane, PubMed and Medline database. Result : The literature search obtained 318 articles in PubMed, 11 articles in Medline,and none in Cochrane, which were relevant with the topic. Only 1 article screened with inclusion and exclusion criteria. A research was conducted by Elizabeth et al in Philipina (2011) on Pediatric Infectious Disease and Hematology-Oncology Services. Out of 26 immunocompromised patients who developed varicella during the study period, only 22 charts were available for review. Of these patients, 13 were male and 9 were female. The highest incidence occurred from 0 to 5 years old (41%). Twenty patients had an underlying malignancy in the form of leukemia (14%) and solid organ tumors (6%) including nasopharyngeal cancer. Diagnosis based on the characteristic generalized papulovesicular rashConclusion : This requires a comprehensive diagnostic panel test for the delivery of appropriate therapy and improved outcome.

PROSES REINTEGRASI SOSIAL ORANG YANG PERNAH MENGALAMI KUSTA (OYPMK) (Studi terhadap mantan penderita kusta di Desa Cangkring, Kecamatan Jenggawah, Jember)

Leprosy has various implications for sufferers starting from physical implications such as the condition of the skin changing to become rough and reddish spots appearing accompanied by decreased immunity, social implications which result in leprosy sufferers being indirectly excluded from the social system in society as well as discrimination, apart from that there are implications economically like losing your job. The condition of leprosy makes it difficult for a person to return to society even though he has been declared cured. There is a phenomenon that some people with leprosy who have experienced discrimination are able to reintegrate into the social system in society. Therefore, this research aims to describe the process of social integration of people who have experienced leprosy into society. The research method used was qualitative with a phenomenological approach on two people with leprosy who live in Cangkring Village, Jenggawah District. The results of this research state that there are two efforts to accelerate social reintegration for people who have experienced leprosy. Firstly, a strong desire based on aspects of cognition, mental and spirituality which is the main strength for a person to be able to push themselves back into society and change their perspective after experiencing leprosy. Second, social approach efforts are carried out consistently to form a communitybounding between someone who has experienced leprosy and the community in the surrounding environment. Success in the social reintegration process allows people who have experienced leprosy to be able to reintegrate into the social system and function socially as members of society such as interacting, starting a family, working and being able to overcome concerns about stigma and discrimination in the community.

Intravenous Thrombolysis for Central Retinal Artery Occlusion: A Look at the Literature for the Emergency Medicine Physician.

Central retinal artery occlusion (CRAO) is a subtype of ischemic stroke and true ocular emergency presenting with acute, painless, monocular vision loss. Typical findings include poor visual acuity (VA), impaired color vision, relative afferent pupillary defect, and on fundoscopic evaluation, retinal edema, cherry red spot, and occasionally visualization of retinal artery emboli. While there are no proven treatments for CRAO, options include orbital massage, hyperbaric oxygen therapy, and intra-arterial or intravenous thrombolysis (IVT). This study reviews the current literature on the efficacy of IVT for patients affected by acute, symptomatic CRAO and provides an up-to-date, evidence-based background for emergency physicians (EPs) who evaluate and manage these patients.

Physics-based optical flow estimation under varying illumination conditions

The physics-based optical flow (PBOF) model was derived from typical flow visualizations and it provided a more solid physical foundation for optical flow calculation. However, like many recent variational optical flow methods, it is not formulated to deal with the effect of illumination variation. In this paper, we propose a new efficient illumination-invariant optical flow estimation method, which improves the physics-based optical flow model. The proposed method introduces a multiplicative product of the velocity gradient and intensity from PBOF and an additive diffusion component to relax the brightness constancy assumption. The proposed method employs a linear transformation to reduce the influence of varying illumination on the data term. Then, a smoothness-sparsity regularization is used to constrain the minimization problem to have good edge-preserving for optical flow. Furthermore, the numerical implementation is given to solve the optimization problem. The accuracy of the developed method and the robustness against varying illumination are evaluated. The proposed method can provide motion estimation with acceptable accuracy for three optical flow datasets and cloud images of Jupiter’s great red spot, which have challenging illumination variations.

Detection and location of microaneurysms in fundus images based on improved YOLOv4 with IFCM

AbstractDiabetic retinopathy (DR) is one of the leading causes of blindness for people suffering from diabetes. Microaneurysm (MA) is the initial symptom of DR. MA is a lesion based disease which starts as small red spots on the retina and increases in size as the DR progresses which finally leads to blindness. So eliminating the lesion can effectively prevent DR at an early stage. However, due to complex retinal structure, different brightness and contrast of fundus images with effects of factors such as different patients, environment changes, and difference in acquisition equipment, it is difficult for existing detection algorithms to achieve accurate results of MA detection and location. Therefore, the detection algorithm of improved YOLOv4 (YOLOv4‐Pro) was proposed. First, an improved Fuzzy C‐Means (IFCM) clustering algorithm was proposed to optimize anchor parameters of target samples to improve matching results between anchors and feature graphs. In order to control noise and improve efficiency, a median filtering method was employed to update the criterion function of the original FCM algorithm, and a K‐means algorithm was employed to initialize clustering. Second, a SENet attention module was added in the backbone of YOLOv4 to enhance key information and suppress background, improving the confidence of MA effectively. Finally, the spatial pyramid pooling (SPP) module was added to the neck to enhance the acceptance domain of the output characteristics of the backbone network, and profits separating of important context information. The improved YOLOv4 with IFCM was verified on the Kaggle DR dataset and compared with other methods. Experimental results show that optimizing the prior frame with the IFCM algorithm can make it suitable to frame the Kaggle DR dataset, which improves the detection accuracy of the network by nearly 5%, and provides a nice performance on detection and location of MA in fundus images. This would help ophthalmologists finding the exact location of MA on retina, thereby simplifying the process and eliminating any manual intervention.

Deep Learning and Minimally Invasive Endoscopy: Automatic Classification of Pleomorphic Gastric Lesions in Capsule Endoscopy.

Capsule endoscopy (CE) is a minimally invasive examination for evaluating the gastrointestinal tract. However, its diagnostic yield for detecting gastric lesions is suboptimal. Convolutional neural networks (CNNs) are artificial intelligence models with great performance for image analysis. Nonetheless, their role in gastric evaluation by wireless CE (WCE) has not been explored. Our group developed a CNN-based algorithm for the automatic classification of pleomorphic gastric lesions, including vascular lesions (angiectasia, varices, and red spots), protruding lesions, ulcers, and erosions. A total of 12,918 gastric images from 3 different CE devices (PillCam Crohn's; PillCam SB3; OMOM HD CE system) were used from the construction of the CNN: 1,407 from protruding lesions; 994 from ulcers and erosions; 822 from vascular lesions; and 2,851 from hematic residues and the remaining images from normal mucosa. The images were divided into a training (split for three-fold cross-validation) and validation data set. The model's output was compared with a consensus classification by 2 WCE-experienced gastroenterologists. The network's performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value and negative predictive value, and area under the precision-recall curve. The trained CNN had a 97.4% sensitivity; 95.9% specificity; and positive predictive value and negative predictive value of 95.0% and 97.8%, respectively, for gastric lesions, with 96.6% overall accuracy. The CNN had an image processing time of 115 images per second. Our group developed, for the first time, a CNN capable of automatically detecting pleomorphic gastric lesions in both small bowel and colon CE devices.

A new report of the stenopodid shrimp Stenopus devaneyi Goy, 1984 from the Western Indian Ocean

The rare stenopodid shrimp, Stenopus devaneyi Goy, 1984, is reported for the first time in the Western Indian Ocean (WIO), at 60 m depth at Mayotte Island. No specimens were collected but the species is recognized confidently on photographs based on its characteristic colour pattern: two large red spots on the sides of the second abdominal somite. Selected colour photos are presented. Former Indo-West-Pacific records are listed with an updated map for the geographic distribution of this shrimp. A few ecological observations are made.

Classification of Tea Leaf Diseases Based on ResNet-50 and Inception V3

Technological advances have made a major contribution to controlling plant diseases. One method for resolving issues with plant disease identification is the use of deep learning for digital image processing. Tea leaf disease is a plant disease that requires fast and effective control. So, in this study, we adopted the Convolutional Neural Network (CNN) architectures, namely ResNet-50 and Inception V3, to classify six types of diseases that attack leaves. The amount of data used was 5867, which were divided into six classes, namely healthy leaf, algal spot, brown blight, gray blight, helopeltis, and red spot. The process of distributing the data involves randomly splitting it into three portions, with an allocation of 80% for training, 10% for validation, and 10% for testing. The process of classification is carried out by adjusting the use of batch sizes in the training process to maximizehyperparameters. The batch sizes used are 16, 32, and 64. Using three different batch size scenarios for each model, it shows that ResNet-50 has better performance on batch size 32 with an accuracy value of 97.44%, while Inception V3 has the best performance on batch size 64 with an accuracy of 97.62%..

Temporal variations in vertical cloud structure of Jupiter's Great Red Spot, its surroundings and Oval BA from HST/WFC3 imaging

Temporal variations in vertical cloud structure of Jupiter's Great Red Spot, its surroundings and Oval BA from HST/WFC3 imaging

Prodigiosin-Producing Serratia marcescens as the Causal Agent of a Red Colour Defect in a Blue Cheese.

Technological defects in the organoleptic characteristics of cheese (odour, colour, texture, and flavour) reduce quality and consumer acceptance. A red colour defect in Cabrales cheese (a traditional, blue-veined, Spanish cheese made from raw milk) occurs infrequently but can have a notable economic impact on family-owned, artisanal cheesemaking businesses. This work reports the culture-based determination of Serratia marcescens as the microbe involved in the appearance of red spots on the surface and nearby inner areas of such cheese. Sequencing and analysis of the genome of one S. marcescens isolate, RO1, revealed a cluster of 16 genes involved in the production of prodigiosin, a tripyrrole red pigment. HPLC analysis confirmed the presence of prodigiosin in methanol extracts of S. marcescens RO1 cultures. The same was also observed in extracts from red areas of affected cheeses. The strain showed low survival rates under acidic conditions but was not affected by concentrations of up to 5% NaCl (the usual value for blue cheese). The optimal conditions for prodigiosin production by S. marscescens RO1 on agar plates were 32 °C and aerobic conditions. Prodigiosin has been reported to possess antimicrobial activity, which agrees with the here-observed inhibitory effect of RO1 supernatants on different bacteria, the inhibition of Enterobacteriaceae, and the delayed development of Penicillium roqueforti during cheesemaking. The association between S. marcescens and the red colour defect was strengthened by recreating the fault in experimental cheeses inoculated with RO1. The data gathered in this study point towards the starting milk as the origin of this bacterium in cheese. These findings should help in the development of strategies that minimize the incidence of pigmenting S. marcescens in milk, the red defect the bacterium causes in cheese, and its associated economic losses.

"The Red Spots Are Now Lava, We Shouldn't Step on Them"-The Joint Creation of Novel Arbitrary Social Contexts in Pretend Play.

Pretend play has been extensively studied in developmental science, nevertheless important questions remain about how children engage in and navigate between pretend episodes. In this proposal, we scrutinize childhood pretense from a social cognitive developmental point of view. First, we review previous theories of pretend play structured around important questions that pinpoint some attributes of pretend episodes, such as their transient and socially defined nature. In these sections, evidence is also reviewed about children's understanding of these attributes. Following this, we describe a novel proposal of pretend play which extends recent accounts of (pretend) play (Wyman & Rakoczy, 2011; Chu & Schulz, 2020a) by exploiting the importance of social interactions in pretense. We contend that engaging in shared pretending can be considered a manifestation of and support for children's ability to participate in and set up arbitrary contextual boundaries with others. These claims are discussed with regards to how pretend play may figure into social development, its potential implications for intra- as well as intercultural variation, as well as future research.

A distinctive new species of the coral shrimp genus Microprosthema Stimpson, 1860 from the Atlantic coast of Florida and Honduras (Decapoda: Stenopodidea: Spongicolidae).

A new species of the spongicolid coral shrimp genus Microprosthema Stimpson, 1860 is described on the basis of three specimens collected by hand while scuba diving off the Atlantic coast of southern Florida, with additional photographic records from Roatan, Honduras. Microprosthema dimitrisorum sp. nov. can be separated from all presently known species of the genus by a unique combination of morphological characters, and most easily, by its highly diagnostic and conspicuous colour pattern consisting of large red spots on most of the body and appendages.

In vitro, ex vivo, and clinical evaluation of anti-aging gel containing EPA and CBD.

Skin aging manifestation, such as coarse wrinkles, loss of elasticity, pigmentation, and rough-textured appearance, is a multifactorial process that can be exacerbated by air pollution, smoking, poor nutrition, and sun exposure. Exposure to UV radiation is considered the primary cause of extrinsic skin aging and accounts for about 80% of facial aging. Extrinsic skin aging signs can be reduced with demo-cosmetic formulations. Both cannabidiol (CBD) and eicosapentaenoic acid (EPA) have been previously suggested as potent active dermatological ingredients. The objective of the current research was to evaluate the compatibility of both agents in the prevention and treatment of skin aging. First, the impact of both agents was assessed using standard photoaging models of UV-induced damage, both in vitro (HaCaT cells) and ex vivo (human skin organ culture). Then, a clinical validation study (n = 33) was performed using an optimized topical cream formulation tested at different time points (up to Day 56). EPA was found to potentiate the protective effects of CBD by reducing the secretion of prostaglandin E2 (PGE2 ) and interleukin-8 (IL-8), two primary inflammatory agents associated with photoaging. In addition, a qualitative histological examination signaled that applying the cream may result in an increase in extracellular matrix (ECM) remodeling following UV radiation. This was also evidenced clinically by a reduction of crow's feet wrinkle area and volume, as well as a reduction of fine line wrinkle volume as measured by the AEVA system. The well-established age-dependent subepidermal low-echogenic band (SLEB) was also reduced by 8.8%. Additional clinical results showed significantly reduced red spots area and count, and an increase in skin hydration and elasticity by 31.2% and 25.6% following 56 days of cream application, respectively. These impressive clinical results correlated with high satisfaction ratings by the study participants. Collectively, the results show a profound anti-aging impact of the developed formulation and strengthen the beneficial derm-cosmetic properties of CBD-based products.

The Potential of Sponge-Associated Bacillus spp. as A Biocontrol Agent to Inhibit Several Bacteria from Infected Catfish (Clarias gariepinus Burch)

Catfish is one of the freshwater aquaculture commodities with a high level of consumption and production in Indonesia. Disease outbreaks could occur in catfish farming activities caused by pathogenic bacteria. Several species of pathogenic bacteria can cause disease in catfish, resulting in mass death. This can lead to decrease in the food quality of freshwater fishery products, especially catfish. In cultured system, aquaculture occurrence of diseases can cause severe financial losses. Catfish samples were obtained from catfish farming with clinical symptoms of reddish spots on the outside of the body. Bacteria were isolated from the kidney and liver under aseptic conditions. These bacteria isolates were identified through their colony morphology, Gram staining, biochemical tests, molecular test, and antibacterial test of Bacillus spp. using spot and disc diffusion test. Identification based on 16S rRNA gene showed that GL1 was 99.92% closely related to Aeromonas widowei, HL1 was 100% closely to Bacillus amyloliquefaciens, and GL2 and HL2 was closely related to Bacillus cereus. The antibacterial test results of APD10 isolates of Bacillus velenzensis species inhibited GL2 pathogenic bacteria with an inhibition zone of 22.15 mm in the very strong inhibition zone and HL2 pathogenic bacteria with an inhibition zone of 8.5 mm in the moderate inhibition zone. Bacillus velezensis was isolated from the sponge Aplysina sp. could be further utilized as a biocontrol agent for the pathogenic bacteria, Bacillus cereus, that infects catfish.

The Potential of Sponge-Associated Bacillus spp. as A Biocontrol Agent to Inhibit Several Bacteria from Infected Catfish (Clarias gariepinus Burch)

Catfish is one of the freshwater aquaculture commodities with a high level of consumption and production in Indonesia. Disease outbreaks could occur in catfish farming activities caused by pathogenic bacteria. Several species of pathogenic bacteria can cause disease in catfish, resulting in mass death. This can lead to decrease in the food quality of freshwater fishery products, especially catfish. In cultured system, aquaculture occurrence of diseases can cause severe financial losses. Catfish samples were obtained from catfish farming with clinical symptoms of reddish spots on the outside of the body. Bacteria were isolated from the kidney and liver under aseptic conditions. These bacteria isolates were identified through their colony morphology, Gram staining, biochemical tests, molecular test, and antibacterial test of Bacillus spp. using spot and disc diffusion test. Identification based on 16S rRNA gene showed that GL1 was 99.92% closely related to Aeromonas widowei, HL1 was 100% closely to Bacillus amyloliquefaciens, and GL2 and HL2 was closely related to Bacillus cereus. The antibacterial test results of APD10 isolates of Bacillus velenzensis species inhibited GL2 pathogenic bacteria with an inhibition zone of 22.15 mm in the very strong inhibition zone and HL2 pathogenic bacteria with an inhibition zone of 8.5 mm in the moderate inhibition zone. Bacillus velezensis was isolated from the sponge Aplysina sp. could be further utilized as a biocontrol agent for the pathogenic bacteria, Bacillus cereus, that infects catfish.

Gambaran Kejadian Sick Building Syndrome (SBS) pada Pegawai Kantor PT. PLN (Persero) UP3 Surabaya Selatan Kota Surabaya

One of the health problem phenomena related to indoor air quality is Sick Building Syndrome (SBS). Sick Building Syndrome (SBS) is a collection of symptoms felt by people who are in the building. The purpose of this study is to provide an overview of the impact of the Sick Building Syndrome (SBS) incident. This research is an analytical observational study. Time of research: February - March 2023. PT. PLN (Persero) UP3 Ngagel, South Surabaya, Surabaya City. from the interview results, there were 45% of respondents who experienced at least 12 symptoms from 20 categories of Sick Building Syndrome (SBS) complaints among office employees of PT. PLN (Persero) UP3 South Surabaya, City of Surabaya. Conclusion: Based on the characteristics of the respondents, it can be seen that the working age of the respondents is mostly> 35 years with the most sex, namely men and the dominant working mass is classified as old > 10 years and smoking habits, namely 73% of respondents do not smoke and 28 respondents have good psychosocial conditions and 2 respondents had poor psychosocial conditions. Of all the symptoms of Sick Building Syndrome, (SBS) complaints that are often felt are dry / hoarse throat (36%), dry skin (29%), skin is often reddish, irritated feeling (21%), rash on the skin, red spots ( 29%), Eye irritation (eyes are often watery/red/itchy, etc.) (36%), Runny nose, sneezing (36%), Chest tightness (36%), Flu-like symptoms (50%), Head dizziness, spinning (29%), Frequent headaches (29%), Drowsiness (36%), Chronic fatigue, lethargy (36%).

Suitability Assessment Method of Red Tourism Development Using Geospatial and Social Humanity Data: A Case Study of Ruijin City, East China

It is important to analyze the trend in land use changes and assess the suitability of resource development for protecting natural resources, developing ecological industries, and land use planning issues. Ruijin City is located in South Jiangxi and has abundant resources for red tourism development. By analyzing the landscape changes in land use and the spatial distribution characteristics of local red culture resources, a supervised machine learning-based prediction model was constructed to quantitatively assess the suitability of red tourism development in a geographic information system (GIS) and the R language environment using geographical, economical, and human-related datasets. The results revealed that: (i) the increasing of human activities and economic vitality provide a beneficial social environment for the development of tourism resources; (ii) highly concentrated red resources, or those with special significance, are conducive to developing red tourism resources; (iii) preferentially, central–eastern Ruijin was followed by the extension areas to peripheral towns, which are potentially suitable areas for the development of red scenic spots. Generally, the findings of this study were consistent with the conventional cognitions and lessons on tourism development, and the constructed evaluation system is expected to be promoted to similar research.

SCDet: A Robust Approach for the Detection of Skin Lesions.

Red, blue, white, pink, or black spots with irregular borders and small lesions on the skin are known as skin cancer that is categorized into two types: benign and malignant. Skin cancer can lead to death in advanced stages, however, early detection can increase the chances of survival of skin cancer patients. There exist several approaches developed by researchers to identify skin cancer at an early stage, however, they may fail to detect the tiniest tumours. Therefore, we propose a robust method for the diagnosis of skin cancer, namely SCDet, based on a convolutional neural network (CNN) having 32 layers for the detection of skin lesions. The images, having a size of 227 × 227, are fed to the image input layer, and then pair of convolution layers is utilized to withdraw the hidden patterns of the skin lesions for training. After that, batch normalization and ReLU layers are used. The performance of our proposed SCDet is computed using the evaluation matrices: precision 99.2%; recall 100%; sensitivity 100%; specificity 99.20%; and accuracy 99.6%. Moreover, the proposed technique is compared with the pre-trained models, i.e., VGG16, AlexNet, and SqueezeNet and it is observed that SCDet provides higher accuracy than these pre-trained models and identifies the tiniest skin tumours with maximum precision. Furthermore, our proposed model is faster than the pre-trained model as the depth of its architecture is not too high as compared to pre-trained models such as ResNet50. Additionally, our proposed model consumes fewer resources during training; therefore, it is better in terms of computational cost than the pre-trained models for the detection of skin lesions.

Evans Syndrome in a Forty-Four Years Old Male Patient: A Case Report

Background: Evans syndrome (ES) is an autoimmune disease characterized by the presence of autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP), together with unknown causes. ES disease is the least common, diagnosed in only 0.8% - 3.7% of all patients with AIHA or ITP. This study aimed to describe Evans syndrome in a 44-year-old male patient.
 Case presentation: A 44-year-old male patient was reported with complaints of weakness and fatigue, red spots, a history of bleeding gums, a history of bleeding from the nose, and a history of red urination. A routine blood examination revealed mild anemia, reticulocytosis, and thrombocytopenia, and the peripheral blood showed polychromatic erythrocytes. Other laboratory examinations revealed an increase in LDH. The results of a positive Comb’s test and antibody screening examination showed the impression of warm-type AIHA. The diagnosis of Evans syndrome in this patient was confirmed by the presence of AIHA and ITP, which co-occur and are primarily due to unknown causes.
 Conclusion: ES is a rare disorder and a diagnosis of exclusion. The diagnosis of ES was established by the presence of signs and symptoms of AIHA and ITP accompanied by a positive direct antiglobulin test with no other etiology found.

Morphological Variations of Nepenthes mirabilis (Lour.) Druce in the Peat Swamp Habitat

Nepenthes mirabilis is a type of lowland Nepenthes. Nepenthes mirabilis has morphological variations in size and color in its natural habitat. This study was conducted with the aim to determine the morphological variations of Nepenthes mirabilis in peat swamp habitat including stems, leaves and pitchers. This research was carried out in Pulu Beruang Village, Tulung Selapan District, Ogan Komering Ilir, South Sumatera. The research method used exploration method. Determination of the observation sample using a random plot method selected by purposive sampling. The parameters observed in this study were the morphological characteristics of Nepenthes mirabilis stems, leaves and sacs as well as environmental factors. Research results, Nepenthes mirabilis has a round stem shape (teres), red and green in color. The leaves are lanceolate, stalked, the edges of the leaves are flat and smooth, the upper surface of the leaves is green or reddish. Waist-shaped pouch, yellowish green in color with red striated and green with red spots.