Stop Gap Research Articles

Analysis of Dental-related Emergency Department Utilization in Michigan

Objective: Emergency departments (ED) are critical to the United States healthcare system. However, they are known to be inefficient environments to deliver definitive care including management of dental emergencies. ED’s may also serve as an inadvertent, but important, stop gap for individuals who lack dental coverage. The nation’s healthcare system continues to struggle with inadequate resources to provide dental care for vulnerable patients who disproportionately suffer from dental-related conditions. Method: This study is an analysis on dental-related ED utilization in the state of Michigan. The authors collaborated with the Michigan Health & Hospital Association who provided data from the Michigan Inpatient and Outpatient Database for dental-related hospital emergency department (ED) visits in Michigan hospitals during 2018-2019. University of Michigan Medical School’s committee on human subjects’ research reviewed the protocol and provided IRB exemption (HUM00192629). Results: State funded Medicaid (33%) and federally funded Medicare (33%) were the most common payer types for patients with dental-related conditions who reported to Michigan ED’s from 2018 to 2019. Charges per ED encounter was the highest for Medicare, $2,900-$3,200, and lowest for other payers, $1,300-$1,500. Charges for ED-inpatient per encounter were the highest for Medicare ($22,000-$24,000). The age range for which patients most frequently presented to the emergency department (ED) was 25-64. However, expenses per encounter for patients 65 and older were roughly two to three times higher than for patients in other age ranges. Conclusion: The study revealed a disproportionately higher percentage of patients who identified as Black presented to Michigan emergency departments (30%) with a dental-related emergency.

Reimagining the ADR Alert Card: a novel approach to recurrence prevention in low-cost settings for adverse drug reactions

ObjectivesAdverse drug reactions (ADRs) are among the leading standalone causes of morbidity and hospitalisation and contribute substantially to an increase in healthcare expenditure. Repeat ADR events, although difficult to quantify,...

Magnetic coupling and amplitude truncation based bistable energy harvester

We present a two-degree-of-freedom bistable piezoelectric energy harvester (PEH) combining both magnetic coupling and amplitude truncation mechanisms to improve the electrical response when installed within compact spaces. The PEH processes a time-varying potential well and each beam has two electrical responses due to the interaction between two magnets. The collision-induced amplitude truncation behavior leads to high-frequency vibration responses, which reduces the matching impedance of the PEH. The Hamilton's principle and the Galerkin method was applied to establish the distributed parameter model for the system. By numerical calculations, the influence of the magnet distance and beam stiffness ratio on the static potential well, as well as the influence of excitation acceleration and stop gap on the voltage and power response were explored. A series of experiments were conducted to validate the voltage and power responses under sweep and fixed frequency excitations. The experimental and simulation results agree with each other. Due to the effect of magnetic coupling, the response frequency bandwidth of the cantilever beam widens by more than 7 Hz. The frequency-up effect generated by collision increases the response power of the system with the maximum of 307.8 mW at 103.6 Ω in experiments, and the combination of the two widens the impedance matching range of the system. This broadband structure with a wide impedance matching range and limited motion is more suitable for practical applications.

The Underexplored Topic of Females who Perpetrate Child Sexual Abuse Material Offenses: What do we know about this Offending Group?

Despite the emerging field of research on females who engage in contact child sexual abuse offenses, we know little about females who engage in child sexual abuse material (CSAM) offenses. This is concerning given the global proliferation of CSAM and recent research identifying female-perpetrated CSAM offending is more prominent than previously thought. This paper contributes to the underdeveloped field, by offering a beneficial and timely stop gap of current research on women who engage in CSAM offenses. In doing so, the synthesis explores the prevalence of females who engage in CSAM, why some females might perpetrate CSAM offenses (including co-offending, prior victimization, mental health, opportunity, and sexual motivation), the harms of female-perpetrated CSAM offending, and how the media portrays this offending group. To further extend our knowledge in this field, ideas for future research are also provided throughout. This paper should be useful for various disciplines including psychology, criminology, and law, globally, who are interested in better understanding CSAM offenses perpetrated by females.

“It’s Like POOF and It’s Gone”: The Live-Streaming of Child Sexual Abuse

The live-streaming of child sexual abuse is an established, and prolific, form of abuse, with high international demand. It involves transmitting the sexual abuse of children in ‘real time’ via a webcam to individuals in any geographical location. Despite it being identified as a global key threat in the area of child sexual exploitation, there is a dearth of literature on this type of offending, limiting our understanding. Until further research is conducted, the current paper fills an important purpose by offering a stop gap of current research on the live-streaming of child sexual abuse. In particular, it draws from a breadth of literature to offer a synthesis of where geographically CSA live-streaming appears to mostly occur; the technological and legal barriers in detecting and prosecuting the behavior; what we know about viewers; what we know about facilitators; and the victims of CSA live-streaming and the impact of the abuse on them. In doing so, this paper offers critical knowledge for research, policy, and practice professionals across psychology, criminology, and law disciplines, who are interested in understanding, preventing, and responding to this form of sexual offending against children.

Blurred boundaries: Muhtarlık as the right space for policy making in Turkey

Turkey’s central government’s administrative structure includes a one-of-a-kind autonomous unit called muhtarlık that spans rural and urban neighborhoods with over 50,000 posts all over the country. Despite being a part of the central administration, muhtarlık is administered by local elections and is considered a hybrid institution that mediates citizens, the local government and the central administration. Muhtarlık originates in the late Ottoman Empire in 1829 as an attempt in modernizing state hierarchies and manages to continue its existence till now as the smallest unit of the administrative structure. However, the long history also causes blurred boundaries for the space the institution occupies. This paper focuses on this blurred space of muhtarlık as a possible policy making incubator and an accessible space for all the relevant stakeholders. In particular, the paper follows through the case study of two very different muhtarlıks in Istanbul to understand the nature of this unique administrative unit. The research concludes that the geographical, social and relational proximity of the muhtarlık with the public as a stop gap unit creates an immense networking example. The paper contributes to the interdisciplinary approaches to policy making by analyzing the juxtaposition of the two processes relevant to policy making and design, the policy analysis and the design thinking process, to model a dynamic policy making process that provides a participative approach. The analysis and observation help explore the possibilities of a space by combining valuable experiences of citizen engagement, governmental tradition and designerly thinking.

Negative-pressure wound therapy as an adjunct to treating pyoderma gangrenosum

Negative-pressure wound therapy has been shown to be effective in re-epithelialisation in recalcitrant pyoderma gangrenosum. This case documents a patient whose co-morbidities limited the standard treatment options and required an alternative management plan. The STOP GAP randomised control trial found that both oral prednisolone and ciclosporin were equally effective in the treatment of pyoderma gangrenosum. However, in this case, the patient had type 2 diabetes and prednisolone resulted in persistently elevated blood glucose levels. Lower doses were ineffective and it was subsequently stopped once other treatments showed a clinical improvement. A recent diagnosis of breast cancer prevented the use of ciclosporin and other immunosuppressive treatments. After multidisciplinary discussion, involving breast surgeons, oncology, dermatology and tissue viability, doxycycline was commenced alongside a portable negative-pressure device with twice weekly tissue viability input. The introduction of this device resulted in a rapid reduction in the wound size and facilitated healing with an excellent outcome.

Navigating the Prevailing Challenges of the Nigerian Power Sector

The Nigerian power sector continues to suffer from the resource curse. With the abundance of natural and renewable energy resources, somehow the Nigerian power sector has failed to meet the energy demand. Over the years, lack of political will and inadequate investments as regards the generation, transmission and distribution of electricity have led to very costly outages. The frequent collapse of the national grid has led to use of diesel/gasoline generators as a stop gap measure for producing electricity. However, this approach significantly increases the cost of production of goods/services (especially with the Russia-Ukraine war) and pollutes the environment/ecosystem. The objective of this paper is to take and in-depth analysis of the problems of the Nigerian power sector beginning with the regulatory framework to the different actors of the Nigerian Electricity Supply Industry NESI (The Gas producers, The Nigerian Gas Company, The Generation Companies, The Transmission Company of Nigeria and the Distribution Companies). Our goal is to achieve a fundamental balance between the affordability, reliability and sustainability of electricity, otherwise known as the energy trilemma.

Polymer-based self-assembled photonic crystals to tune light transport and emission.

The advent of photonic crystals has made possible the idea of controlling flows of light, which has revolutionized photonics-based technology. Photonic crystals are constructed based on periodic refractive index variations in one-, two-, or three-spatial dimensions on the optical-wavelength scale. Photonic crystals show inherent photonic stop gaps or band gaps depending upon the crystal symmetry and refractive index contrast. Showing ease of fabrication, polymer-based self-assembled photonic crystals with stop gaps have been widely explored. We discuss angle- and polarization-dependent stop gap creation and splitting at higher angles of incidence. The observed stop gaps in self-assembled photonic crystals often deviate from theoretical predictions due to experimental constraints, such as finite size and fabrication disorders associated with samples. We perform micro-reflectivity experiments on a single domain, showing minimal disorder, with nearly 100% reflectivity, which is in agreement with theory. We obtain more than 75% emission intensity suppression and a 30% increase in the emission lifetime at the stop gap using micro-emission experiments in a single domain. This enables us to study the role of finite-size effects in photonic crystals in modifying the emission properties. We observe the linear scaling of the emission intensity suppression and the emission rate with the finite size of the crystal. Our single-domain experimental studies reveal that the use of low index-contrast self-assembled photonic crystals is a potential platform for strategically modifying light transport and emission properties.

Insecticidal potency of mixtures of plant powders and Actellic SuperTM (Pirimiphos-methyl + Permethrin) on Callosobruchus chinensis F. and Sitophilus zeamais Motch

Insect pests still cause substantial quantitative and qualitative grain loss ranging from 20 to 100% in small holder farming systems in tropical countries. Synthetic pesticides are recommended as stop gap measures for the management of stored product insect pests. However, their application has not been fully exploited in small scale farming due to environmental, health, and economic concerns. As a result, new researches have shifted focus to exploiting pesticidal plants as alternatives to synthetic pesticides. Therefore, the current study evaluated mixtures of plant powders and reduced amount of Actellic superTM (pirimiphos-methyl + permethrin) as alternative insecticide formulation against Callosobruchus chinensis and Sitophilus zeamais. Green grams and wheat grains were mixed with a mixture of plant powders in the ratios of 1:1, 1:3 and 1:9 to obtain four rates (0.0, 2.0, 6.0 and 10%w/w). Grains and plant powders were also mixed with reduced amount (10, 25, and 50 %) of recommended rate of Actellic SuperTM to obtain dosages as above. Twenty unsexed adults, 1-5 day old S. zeamais and C. chinensis were introduced into treated grains. The mixture of C. lusitanica: T. vogelii powders in the ratios of 1:1, 1:3 and 1:9 caused mortality in C. chinensis of 55, 95 and 85%, respectively. At the same ratio, E. saligna: L. camara mixture produced mortality in S. zeamais of 77, 82, and 85% respectively. In mixture of C. lusitanica and T. vogelii and reduced amount of Actellic SuperTM by 50% the mortality of C. chinensis was 85 and 80 % respectively. Similarly, E. saligna and L. camara and reduced amount of Actellic SuperTM by 50% caused a mortality of S. zeamais of 48 and 97% respectively. The application of plant powders and reduced amounts of synthetic insecticide has the potential to be applied in stored product pest control

Quinoid-Aromatic Resonance for Very Small Optical Energy Gaps in Small-Molecule Organic Semiconductors: A Naphthodithiophenedione-oligothiophene Triad System.

Organic semiconductors with very small optical energy gaps have attracted a lot of attention for near-infrared-active optoelectronic applications. Herein, we present a series of donor-acceptor-donor (D-A-D) organic semiconductors consisting of a highly electron-deficient naphtho[1,2-b:5,6-b']dithiophene-2,7-dione quinoidal acceptor and oligothiophene donors that show very small optical energy gaps of down to 0.72 eV in the solid state. Investigation of the physicochemical properties of the D-A-D molecules as well as theoretical calculations of their electronic structures revealed an efficient intramolecular interaction between the quinoidal acceptor and the aromatic oligothiophene donors in the D-A-D molecules; this significantly enhances the backbone resonance and thus reduces the bond length alternation along the π-conjugated backbones. Despite the very small optical energy gaps, the D-A-D molecules have low-lying frontier orbital energy levels that give rise to air-stable ambipolar carrier transport properties with hole and electron mobilities of up to 0.026 and 0.043 cm2 V-1 s-1 , respectively, in field-effect transistors.

Electricity Generation Options for India-A Critical Evaluation

Objectives : This review is to study the electricity generating energy sources in the world at large and India in particular, considering the impact on the environment and arrive at the energy sources which India needs to focus in the future. Methods : The world data on the various aspects like greenhouse emissions, deaths, health effects, levelized cost of electricity, energy return on investment, water, and land requirements for various energy sources have been studied. Findings : The need for reduction of energy from coal is clear as its emissions affect the health and contribute to climate changes. The alternative large source appears to be nuclear. Wind and solar power with low emissions of Greenhouse gases are also favored. However, wind is seasonal and solar power can be generated only during daytime which leads to low-capacity factor (~20%) compared to 32% for nuclear and 42% for Coal plants. This has also impact on the grid management. The environmental impacts of Nuclear, Coal, Solar, Wind and Hydro have been brought out in detail. More weightage is given to sources that have a higher growth rate based on the energy return on investment and environmental impacts rather than capital cost. The accidents of nuclear reactors in USA, Russia and Japan have shaken the public faith in nuclear power. The real fact that the impacts on the health of the people due to release of radiation in these accidents is negligible has been brought out. Comparison between natural and manmade radiation has been brought out. Finally, the applicability of energy sources in the context of India are discussed and a ranking approach arrived at. Recommendations : Nuclear has been favored based on the availability of natural uranium and thorium in the country and long-term energy security. Solar and wind need to be deployed, wherever possible, in view of the slow introduction of nuclear reactors due to high capital cost. Import of nuclear designs from abroad is also recommended to meet the electricity demands as a stop gap arrangement. Novelty : This study has taken a ranking approach considering most important metrices and has applied to India. Keywords: Pollution, coal, hydro, biomass, nuclear, risk, benefits

Beyond the ‘stop gap’: young (adult) women’s experiences of living with parents in the aftermath of the Greek austerity crisis

In the context of greater strains imposed by the post-2008 global financial crisis, it has become more commonplace for young people to live with their parents for extended periods. Beyond a domination of Anglophone research, far less is known about whether these experiences of living with parents vary in countries with different economic and cultural contexts. This article focuses on young women in contemporary Greece – a society undergoing radical social restructuring in the wake of the post-2008 economic crisis. Drawing on qualitative interviews with young university-educated women in urban Greece (n=36), the article argues that the current fiscal crisis alongside long-standing patriarchal norms place a significant burden on the lives of these young women. It concludes that evaluation of the impact of financial crisis on the living arrangements of young people should carefully assess the interaction of the gender and cultural aspects of family lives.

Abstract 38: Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya.

Abstract Purpose: Quality Cancer treatment is expensive and not accessible to all in LMIC settings in sub-Saharan Africa including Kenya. Despite having a cancer diagnosis, patients and their families not living in major towns and cities, have to travel far to seek treatment incurring cost in transport, upkeep during treatment and out of pocket expenditure to access care. Methods: International Cancer Institute in Eldoret-Kenya, partnered with Taita Taveta County to implement a cancer and other non-communicable disease (NCD) project in August 2020. Taita Taveta County established a technical working group (TWG) in September 2020 to oversee the project activities and identified space and staff to set up a new cancer clinic. ICI provided technical support in project planning, budgeting, capacity/needs assessment, training and mentorship of healthcare providers; and running joint cancer clinics. Results: Periodic review meetings between ICI and Taita Taveta County TWG identified lack of: qualified staff to provide cancer care; cancer screening supplies; and drug stock-outs. In September 2020, ICI and its strategic partners supported Taita Taveta County to launch a Cancer Clinic to provide basic Cancer care. ICI offered trainings and continuous medical education on cancer for 91 healthcare providers both online (26) and on-site (65); ICI provided cervical, breast and prostate cancer screening supplies; established a revolving fund pharmacy as a stop gap measure to drug stock-outs; and held joint cancer clinics twice a month where mentorship and skills training for county staff paired with ICI staff across various disciplines was achieved resulting in the first patient receiving chemotherapy in November 2020; histopathology support was provided for 151 samples. Conclusion: The process of setting up a cancer clinic in a low resource setting requires a systematic needs assessment approach; identifying a core team early that outlines output measures of interest; and having strategic partnership guiding step-by-step developments. Citation Format: Gloria Kitur, Emmah Achieng, Rebecca Mwakichako, Felix Kimotho, Chite Asirwa. Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya. [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 38.

Quality Evaluation of African Eggplant Stored in Evaporative Coolers

Postharvest cooling of fresh produce is essential to delivering high quality produce to the consumer. African eggplants are chilling sensitive at temperatures below 10°C, there is need to store them at higher temperatures because of their tropical nature. Evaporative coolers suitable for tropical fruits storage were therefore designed and constructed. Essentially, the evaporative coolers comprised of double burnt-brick walls (1.29 × 2.55× 2.56) m external and (1.13 × 1.27 × 2.08) m internal (L × W × H). A study was conducted to evaluate the physicochemical, microbial and sensory parameters of African eggplant stored in two evaporative coolers- aluminum-cladded burnt-clay-brick evaporative cooler (ABBEC) and non-cladded burnt-clay-brick evaporative cooler (NBBEC). Weight loss, total soluble solids, total titratable acidity, beta carotene content, ascorbic acid content, pH and microbial load were assessed during storage. Metabolic rates of African eggplant were highest at ambient storage, intermediate in NBBEC with the least value in ABBEC. Beta carotene, ascorbic acid and acidity decreased while total soluble solids, pH and microbial load increased during storage of African eggplant. The evaporative coolers reduced the storage temperature and increased the relative humidity within normal level of storage thereby extending the shelf life of eggplant from ten days at ambient to twenty-one days in ABBEC storage condition. ABBEC storage is therefore recommended for stop gap extension of shelf lives of fresh produce.

Non-smooth dynamics of articulated pipe conveying fluid subjected to a one-sided rigid stop

The mathematical model and non-smooth dynamics of a two-segment articulated pipe conveying fluid with the upper segment subjected to a one-sided rigid stop is investigated. To determine the effect of the one-sided rigid stop on the impacting behaviors of the articulated pipe under various geometrical and physical parameters, the nonlinear equations of motion combined with the rigid impacting condition are established and solved by a fourth-order Runge-Kutta algorithm. In the linear analysis, the stabilities and critical flow velocities of the articulated pipe are analyzed by examining the linearized equations without the rigid stop. Typical results of stability boundaries are compared to those reported previously and good agreement is obtained. In the nonlinear analysis, bifurcation diagrams and phase portraits of the responses of the upper and lower segments are presented and discussed by considering the effects of mass ratio, stiffness ratio, stop gap and coefficient of restitution. Periodic and chaotic vibro-impact oscillations are observed, with a particular interest in the detecting of the possibility of stick-slip motions which show the non-smooth vibrating characteristics of this rigid impacting system. It is shown that the coefficient of restitution for impact has a great effect on the chaotic oscillations and stick-slip motions of the pipe. Results obtained in this work highlight the complexity of the nonlinear impacting dynamics of articulated pipes conveying fluid with a rigid stop. It is also expected, in the near future, to extend the basic idea of this work to explore the nonlinear responses of flexible pipes and hoses conveying fluid subjected rigid stops by introducing a multi-segment articulated pipe model.

Observation of finite-size-induced emission decay rates in self-assembled photonic crystals

We study the extent of spontaneous emission inhibition in self-assembled photonic crystals where the light path is routinely affected by unavoidable imperfections of the crystal and its finite-size. We discuss the role of finite-size effects that inadvertently modify the local density of optical states (LDOS) using time-resolved decay rate measurements from the single domains of real synthesized photonic crystals. We have obtained 34% contrast in the measured emission lifetimes at the stop gap wavelength in comparison to a wavelength outside the stop gap. We have shown a remarkable variation in the emission lifetimes at the stop gap for several domains across the sample which is nullified within a single domain. The results manifest wavelength-dependent linear scaling of lifetimes with the finite-size of the crystal domain. This is a signature of direct dependence of LDOS suppression on the crystal's finite-size which is also found to be in accordance with a recent theoretical model. The precise single-domain measurements result in a robust modification of lifetime in an otherwise weakly classified self-assembled photonic crystal.

Quality Evaluation of Fresh Tomato Stored in Evaporative Coolers

A study was conducted to assess the performance of evaporative coolers for the storage of fruits and vegetables. Two evaporative coolers [Aluminum-cladded burnt-clay-brick evaporative cooler (ABBEC) and non-cladded burnt-clay-brick evaporative cooler (NBBEC)] for the storage of fruits and vegetables were designed, constructed and tested. The evaporative coolers comprised of double burnt-brick walls (1.29×2.55×2.56 m) external and (1.13×1.27×2.08 m) internal, (L×W×H). The physicochemical, microbiological and sensory attributes of fresh tomatoes stored in the coolers and at ambient were evaluated. Metabolic rates of tomatoes were highest at ambient storage followed by NBBEC with the least value in ABBEC. Beta carotene, ascorbic acid and acidity decreased while total soluble solids, pH and microbial loads increased during storage of tomatoes. Fresh tomatoes stored in ABBEC exhibited lower biochemical and physiological reaction rates hence tissue breakdown, colour changes, pH and titratable acidity were lower in ABBEC than NBBEC and ambient. ABBEC storage further improved the microbial quality and shelf life of fresh tomatoes. The aluminum cladded evaporative cooler was the best storage facility for stop gap extension of shelf life of tomatoes.

Effect of Clear Speech on the Duration of Silent Intervals at Syntactic and Phonemic Boundaries in the Speech of Individuals With Parkinson Disease.

Purpose The purpose of the current investigation was to determine the extent to which individuals with and without Parkinson disease (PD) modified silent interval durations when using a clear speaking style. Method Ten individuals with idiopathic PD and 10 older adult control speakers produced a reading passage using both habitual and clear speaking styles. Silent intervals lasting 15 ms and longer were identified and extracted. Each silent interval was categorized according to the surrounding syntactic context of the reading passage. In addition, voiceless stop gaps that occurred within words, phrases, or clauses were categorized by the preceding phonemic context. Results Statistical analyses revealed that all participants increased silent interval duration with a clear speaking style at inter-sentence and intra-sentence syntactic boundaries. Compared to controls, individuals with PD exhibited significantly less increase in silent interval durations at these syntactic boundaries. Control speakers also increased silent stop gap durations in the clear speaking style regardless of preceding phonemic context. Individuals with PD, however, only increased stop gap duration when the silent interval was preceded by a sonorant. Conclusion These findings suggest that speakers with PD exhibit less clarity-related increase in silent interval duration than control speakers. In addition, speakers with PD exhibited significant increases in silent interval duration that coincided with syntactic boundaries of the reading passage but little to no clarity-related modulation of stop gap intervals. Therefore, these data suggest that speakers with PD exhibited changes in silent interval durations that were more so associated with modulation of speech prosody than articulation when using a clearer speaking style.

Characterization of Government Entreprenurial Human Capacity Building and its Impact on Business Profile of Women Entreprenuers in Abia State, Nigeria

This study evaluated the extent of inclusion and participation of Women in Human capacity Building of a State in Nigeria. One hundred female business owners who graduated from skill acquisition centres of Abia state were randomly sampled to determine access to capacity building programmes, relevance of skills offered in programmes and type of business operation. Results showed that the 30% women affirmation policy as implemented by Abia State Government is an important factor in women entrepreneurial development. The Human Capacity building of Women entrepreneurs are tailored as stop gap. Even as petroleum producing state with strong financial base, her human capacity building strategies lack depth and are less consistent with entrepreneurial goals of women with tertiary level education. Irrespective of the state cosmopolitan status the human capacity building strategies are challenged by male dominated bureaucracy and cultural perception of female roles. A significant number (68% ) of women endorsed government policies. Seventy (70%) percent of women with tertiary education level viewed the skills offered in human capacity building as irrelevant to their training needs and entrepreneurial aspirations.Financial independence and Technology knowledge base influenced choice of business operations. The service sector was observed as the predominant choice of women.Empowerment support facilitation was suggestive of gender disparity in capacity building programmes.