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List of largest cities
Determining the world's largest cities depends on which definitions of city are used, as well as the criteria used for size: this article focuses on population. The United Nations uses three definitions for what constitutes a city, as not all cities may be classified using the same criteria.[1] Cities may be defined as the cities proper, the extent of their urban area, or their metropolitan regions.[1]
For a view of the largest cities by economic stature and integration within the global economy, see Globalization and World Cities Research Network.
1 Common methods for defining the boundaries of a city
1.1 City proper (administrative)
1.2 Metropolitan area
1.3 Urban area
2 Largest cities
2.1 Megacities
2.2 Cities and urban areas with over a million inhabitants
Common methods for defining the boundaries of a city
City proper (administrative)
For a more comprehensive list, see List of cities proper by population.
A city can be defined by its administrative boundaries (city proper). UNICEF[1] defines city proper as "the population living within the administrative boundaries of a city or controlled directly from the city by a single authority." A city proper is a locality defined according to legal or political boundaries and an administratively recognised urban status that is usually characterised by some form of local government.[2][3][4] Cities proper and their boundaries and population data may not include suburbs.[5]
The use of city proper as defined by administrative boundaries may not include suburban areas where an important proportion of the population working or studying in the city lives.[5] Because of this definition, the city proper population figure may differ greatly with the urban area population figure, as many cities are amalgamations of smaller municipalities (Australia), and conversely, many Chinese cities govern territories that extend well beyond the traditional "city proper" into suburban and rural areas.[6]
For a more comprehensive list, see List of metropolitan areas by population.
A city can be defined by the inhabitants of its demographic population, as by metropolitan area, labour market area, or similar in a metropolitan area. UNICEF[1] defines metropolitan area as follows:
A formal local government area comprising the urban area as a whole and its primary commuter areas, typically formed around a city with a large concentration of people (i.e., a population of at least 100,000). In addition to the city proper, a metropolitan area includes both the surrounding territory with urban levels of residential density and some additional lower-density areas that are adjacent to and linked to the city (e.g., through frequent transport, road linkages or commuting facilities).
For a more comprehensive list, see List of urban areas by population.
See also: Number of urban areas by country
A city can be defined as a conditionally contiguous urban area, without regard to territorial or other boundaries inside an urban area. UNICEF[1] defines urban area as follows:
The definition of "urban" varies from country to country, and, with periodic reclassification, can also vary within one country over time, making direct comparisons difficult. An urban area can be defined by one or more of the following: administrative criteria or political boundaries (e.g., area within the jurisdiction of a municipality or town committee), a threshold population size (where the minimum for an urban settlement is typically in the region of 2,000 people, although this varies globally between 200 and 50,000), population density, economic function (e.g., where a significant majority of the population is not primarily engaged in agriculture, or where there is surplus employment) or the presence of urban characteristics (e.g., paved streets, electric lighting, sewerage).
Many of the world's largest cities, metropolitan areas, and urban areas are further delineated into neighborhoods, and even into villages or towns. Major cities usually form the basis of megacities and megalopolis. These can extend well beyond proper area, including megalopolis areas such as Keihanshin, which contains the cities of Kyoto, Osaka, and Kobe. And a megalopolis, otherwise known as a megaregion, can take form in vast areas such as the Southern Rocky Mountain Front, which can contain several metropolitan areas, in this case Denver, Colorado, and Albuquerque, New Mexico.
The following cities have a population greater than 10 million within either city proper, metropolitan area, or urban area.
City proper
Urban area[7]
Chongqing China 30,484,300
[8] 30,484,300
[9] 8,518,000
Shanghai China 24,256,800
[11] 24,750,000
Beijing China 21,516,000
Lagos Nigeria 861,300
[15][c] 21,000,000
Mumbai India 12,478,447
Dhaka Bangladesh 8,906,039
Chengdu China 16,044,700
Karachi Pakistan 14,910,352
Guangzhou China 14,043,500
[27] 25,000,000[28] 20,800,654
Istanbul Turkey 14,025,000
[30] 13,520,000 14,657,000
Tokyo Japan 13,839,910
Tianjin China 12,784,000
[citation needed] 6,859,779
Moscow Russia 12,197,596
São Paulo Brazil 12,252,023
Kinshasa DR Congo 11,855,000
[38] 13,265,000 1,038,195
Delhi India 11,034,555
Baoding China 11,194,372
[42] 2,176,857
Lahore Pakistan 11,126,285
Wuhan China 11,081,000
Cairo Egypt 10,230,350
Seoul Korea, South 10,197,604
Jakarta Indonesia 10,075,310
Lima Peru 9,174,855
Mexico City Mexico 9,041,395
London United Kingdom 8,825,001
Bangkok Thailand 8,750,600
[citation needed] 15,645,000
Xi'an China 8,705,600
Bangalore India 8,425,970
New York United States 8,622,698
Ho Chi Minh City Vietnam 8,993,082
Shenzhen China 8,378,900
[64][d] 12,084,000
Suzhou China 10,459,890
Nanjing China 8,230,000
Tehran Iran 8,154,051
Rio de Janeiro Brazil 6,718,903
Shantou China 5,391,028
Kolkata India 4,486,679
Shijiazhuang China 4,303,700 10,701,600 4,303,700
Harbin China 10,635,971
Los Angeles United States 3,884,307
Buenos Aires Argentina 3,054,300
Osaka Japan 2,691,742
Nagoya Japan 2,296,014
Paris France 2,229,621 12,405,426 10,601,122
Manila Philippines 1,780,148
Cities and urban areas with over a million inhabitants
The following cities have a population greater than 1 million and less than 10 million within either city proper, metropolitan area, or urban area. They typically are a key component of a megalopolis.
Kuala Lumpur Malaysia 1,768,000
Cebu City Philippines 922,611
Maputo Mozambique 1,766,184 1,766,823
Budapest Hungary 1,759,407
Warsaw Poland 1,753,977
Lusaka Zambia 1,742,979 2,467,467
Kathmandu Nepal 1,744,240 2,517,023 3,207,205
Tabriz Iran 1,733,033
Hyderabad Pakistan 1,732,693
Palembang Indonesia 1,708,413
Tijuana Mexico 1,696,923 1,895,797
Patna India 1,683,200 2,231,554 2,046,652
Montreal Canada 1,649,519 4,127,100 3,407,963
Davao City Philippines 1,632,991
Harare Zimbabwe 1,606,000 1,619,000
Barcelona Spain 1,604,555
[85] 5,375,774 4,740,000
Maracaibo Venezuela 1,599,940
Caloocan Philippines 1,583,978
[74][f]
Philadelphia United States 1,567,872
Novosibirsk Russia 1,567,087
Phoenix United States 1,563,025
Oran Algeria 1,560,329
Semarang Indonesia 1,555,984 3,183,516
Recife Brazil 1,645,727
Kobe Japan 1,536,499
[73][g]
Daejeon Korea, South 1,535,028
Kampala Uganda 1,507,080
Kawasaki Japan 1,496,035
[73][h]
Guadalajara Mexico
Auckland New Zealand 1,495,000
Vijayawada India 1,491,202
Fukuoka Japan 1,483,052
Gwangju Korea, South 1,477,780
Porto Alegre Brazil 1,483,771
Kyoto Japan 1,474,570
[73][i]
San Antonio United States 1,469,845
[100] 2,454,061
Santa Cruz de la Sierra Bolivia 1,453,549
Munich Germany 1,450,381
Kharkiv Ukraine 1,449,414
Yekaterinburg Russia 1,428,042
San Diego United States 1,394,928
[100] 3,095,313 2,956,746
Barranquilla Colombia 1,386,865
Milan Italy 1,359,905
Ibadan Nigeria 1,338,659 2,837,000 3,375,000
Makassar Indonesia 1,338,633 1,976,168
Córdoba Argentina 1,330,023
Prague Czech Republic 1,324,000
Mandalay Myanmar 1,319,452
Dallas United States 1,317,929
Montevideo Uruguay 1,305,082
Qom Iran 1,201,158
Ahvaz Iran 1,184,788 1,260,817
Sofia Bulgaria 1,260,120 1,682,340 1,547,472
Kazan Russia 1,251,969 1,560,000
Nizhny Novgorod Russia 1,250,619
Abuja Nigeria 1,235,880 6,000,000
Calgary Canada 1,235,171
Saitama Japan 1,226,656
[73][k]
Suwon Korea, South 1,202,310
Hiroshima Japan 1,196,274
Rosario Argentina 1,193,605
Brisbane Australia 1,180,285
[119][120]
Allahabad India 1,117,094
Belgrade Serbia 1,166,763
Campinas Brazil 1,204,073
Ulsan Korea, South 1,163,690
Albuquerque United States 560,218
[122] 915,927
Omsk Russia 1,154,116
Dakar Senegal 1,146,053
Abu Dhabi United Arab Emirates 1,145,000
Monterrey Mexico 1,109,171
Tripoli Libya 1,126,000
[citation needed] 2,267,000 2,325,000
Rostov-on-Don Russia 1,119,900
T'bilisi Georgia 1,118,035
Fez Morocco 1,112,072
Birmingham United Kingdom 1,111,300
Yerevan Armenia 1,060,138
Cologne Germany 1,057,327
Tunis Tunisia 1,056,247
Bulawayo Zimbabwe 1,050,000
Nur-Sultan Kazakhstan 1029556
Islamabad Pakistan 1,014,825
Cartagena Colombia 1,013,389
Tucson United States 545,975 843,168 1,010,025
Geography portal
Lists portal
List of largest cities throughout history
List of towns and cities with 100,000 or more inhabitants
Number of urban areas by country
^ Sum of the 2014 population estimates for the "urban-function core district" and "urban-function extended district" of Chongqing, which were 3,677,600 and 4,512,200 respectively.[10]
^ Shanghai, Hangzhou, Nanjing, Suzhou, Wuxi, Ningbo, Changzhou, Shaoxing, and urban area of Zhangjiaggang-Jiangyin within the prefecture-level cities of Suzhou and Wuxi are treated as separate urban areas which constitute the Yangtze River Delta economic zone. Huai'an (1,856,000; 148 km2), Xuzhou (1,246,000; 233 km2), Nantong (1,036,000; 233 km2), Lianyungang (985,000; 155 km2), Zhenjiang (983,000; 168 km2), Yancheng (797,000; 207 km2), Huzhou (690,000; 111 km2), Taizhou (in Jiangsu Province; 300,000; 117 km2) and Suqian (220,000; 36 km2), as well as urban areas of Yangzhou (1,593,000; 233 km2) and Gaoyou (180,000; 39 km2) within the prefecture-level city of Yangzhou, urban areas of Kunshan (1,596,000; 492 km2), Changshu (1,139,000; 285 km2) and Taicang (523,000; 117 km2) within the prefecture-level city of Suzhou, urban areas of Cixi (1,200,000; 298 km2) and Yuyao (650,000; 122 km2) within the sub-provincial city of Ningbo, urban areas of Jiaxing (1,044,000; 259 km2) and Tongxiang (510,000; 52 km2) within the prefecture-level city of Jiaxing, urban areas of Wenling (510,000; 52 km2), Jiaojiang (375,000; 41 km2) and Huangyan (200,000; 34 km2) within the prefecture-level city of Taizhou (in Zhejiang Province), urban areas of Zhuji (500,000; 117 km2) and Shangyu (400,000; 158 km2) within the prefecture-level city of Shaoxing, urban areas of Yiwu-Dongyang (925,000; 233 km2), Jinhua (520,000; 186 km2), Yongkang (500,000; 223 km2), Dongyang (260,000; 104 km2) and Lanxi (220,000; 34 km2) within the prefecture-level city of Jinhua, and urban area of Fuyang (450,000; 49 km2) within the sub-provincial city of Hangzhou are also excluded.
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^ The cities of Yokohama, Kawasaki and Saitama are all part of the Greater Tokyo Area
^ Milan and its neighbouring comunes are all under the administration of Metropolitan City of Milan
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^ "Чисельність населення (щомісячна інформація)". Central Directorate of Statistics of Kharkov region. 1 February 2018. Archived from the original on 4 May 2017. Retrieved 21 April 2018.
^ "Major Agglomerations of the World". citypopulation.de. 1 January 2017. Archived from the original on 4 July 2010. Retrieved 15 June 2017.
^ a b "Resident population by age, nationality and borough". Alcaldía de Barranquilla - City Hall of Barranquilla (Spanish). Archived from the original on 28 September 2015.
^ "Resident population by age, nationality and borough". City of Milan – Statistical Department. Archived from the original on 2 February 2017.
^ "INDEC: estimaciones de población" (PDF). Archived from the original (PDF) on 9 April 2014. Retrieved 22 April 2014.
^ "Prague Population 2017 - World Population Review". worldpopulationreview.com. Archived from the original on 5 August 2017. Retrieved 5 August 2017.
^ Census Report. The 2014 Myanmar Population and Housing Census. 2. Naypyitaw: Ministry of Immigration and Population. May 2015. p. 57. Retrieved 26 April 2017.
^ Bureau, US Census. "The South Is Home to 10 of the 15 Fastest-Growing Large Cities". Archived from the original on 15 July 2017. Retrieved 5 August 2017.
^ "Dallas Bureau of Economic Analysis". Bureau of Economic Analysis. Archived from the original on 11 July 2017. Retrieved 8 May 2017.
^ "United States Urban Areas". United States Census Bureau. Archived from the original on 22 July 2017. Retrieved 8 May 2017.
^ "Censos 2011 - Instituto Nacional de Estadística". www.ine.gub.uy. Archived from the original on 12 July 2017.
^ a b "ВПН-2010". gks.ru. Archived from the original on 15 March 2013. Retrieved 5 August 2017.
^ Editor, Online (29 March 2016). "FCT Minister Harps on Development of Satellite Towns". Archived from the original on 6 August 2017. Retrieved 5 August 2017. CS1 maint: extra text: authors list (link)
^ "Census Profile: Calgary, Alberta (Population Centre)" (PDF). Statistics Canada. 1 April 2016. Archived (PDF) from the original on 18 August 2016. Retrieved 5 February 2017.
^ "Provincia de Santa Fe, departamento Rosario. Población total por país de nacimiento, según sexo y grupo de edad. Año 2010" (PDF). INDEC. Archived from the original (PDF) on 26 August 2014.
^ "Encuesta Permanente de Hogares. Resultados del segundo trimestre de 2012" (PDF). INDEC. Archived from the original (PDF) on 29 October 2013.
^ "Brisbane (C) Local Government Area community profile". Archived from the original on 18 April 2017. Retrieved 17 April 2017.
^ "2011 Census Community Profiles: Brisbane". ABS Census. Australian Bureau of Statistics. Archived from the original on 10 July 2017. Retrieved 15 September 2016.
^ "Ten years of growth: Australia's population hot spots". Australian Bureau of Statistics. 28 July 2017. Archived from the original on 28 July 2017. Retrieved 4 August 2017.
^ a b c "2011 Census of Population, Households and Dwellings in the Republic of Serbia: Comparative Overview of the Number of Population in 1948, 1953, 1961, 1971, 1981, 1991, 2002 and 2011, Data by settlements" (PDF). Statistical Office of Republic Of Serbia, Belgrade. 2014. ISBN 978-86-6161-109-4. Retrieved 27 June 2014.
^ https://www.census.gov/programs-surveys/popest/data/tables.2017.html
^ http://www.abq.org/Demographics.aspx
^ https://factfinder.census.gov/bkmk/table/1.0/en/PEP/2018/GCTPEPANNR.US41PR
^ a b UN Data Archived 19 February 2017 at the Wayback Machine. Projection based on 2002 census.
^ "(Russian)" (PDF). Archived (PDF) from the original on 2 July 2017. Retrieved 5 August 2017.
^ "Preliminary Results of 2014 General Population Census of Georgia" (PDF). NATIONAL STATISTICS OFFICE OF GEORGIA. Archived (PDF) from the original on 1 May 2015. Retrieved 30 April 2015.
^ "Morocco 2014 Census".
^ "Armstat" (PDF). Archived (PDF) from the original on 10 October 2017. Retrieved 5 August 2017.
^ "Muenchen in Zahlen". Landesbetrieb Information und Technik NRW (in German). Archived from the original on 14 July 2016. Retrieved 18 July 2016.
^ History of Zimbabwe. Demographia. Retrieved 11 August 2017. ISBN 9781435733497. Archived from the original on 11 August 2017.
^ "stat.gov.kz". stat.gov.kz.
^ Жулмухаметова, Жадра (31 October 2017). "Чиновники работают над тем, чтобы уместить в Астане два миллиона человек". InformBuro.kz. Retrieved 24 January 2018.
^ Cite error: The named reference auto9 was invoked but never defined (see the help page).
^ http://www.dane.gov.co/files/investigaciones/poblacion/proyepobla06_20/Municipal_area_1985-2020.xls
UNSD Demographics Statistics – City population by sex, city and city type
Nordpil World Database of Large Urban Areas, 1950–2050


text:
A remarkable vision
Jack Ladenson brings hope to patients throughout the world
By Michael C. Purdy February 13, 2008
Life in laboratory medicine strives for explicit and predictable plans of action: Test A leads either to Diagnosis B or C or to follow-up Test D.
When he looks back on his life so far, though, Jack Ladenson, Ph.D., the Oree M. Carroll and Lillian B. Ladenson Professor of Clinical Chemistry, often finds an entertaining lack of predictability. He laughs loudest when he remembers how long he originally thought he'd stay at Washington University: "no more than three to five years."
A medical evaluation team from St. Louis in Eritrea: (from left) Jason Goldfeder, M.D.; Jack Ladenson, Ph.D.; Debbie Witte; Cindy Merrins; Gaye Knutsen; David Windus, M.D.; and Ruth Ladenson.
Ladenson came to the University more than three and a half decades ago.
A few years after his arrival, researchers developed the ability to make monoclonal antibodies. The immune system uses antibodies to seek out invaders and label them for attack and disposal. Monoclonal antibodies promised to put the abilities of these molecular bloodhounds at scientists' disposal.
Around that time, rapid and reliable heart attack diagnosis was a high clinical priority. New treatments were in the pipeline for heart disease, a leading cause of mortality, but to maximize their effectiveness, physicians needed to know quickly if patients were really having a heart attack.
Ladenson and several colleagues found themselves ideally positioned to see if specific monoclonal antibodies could enable quick, accurate heart attack diagnosis.
"All at once, a number of people were anxious to give us research money to develop monoclonal antibodies," Ladenson says. "That was kind of extraordinary."
In the mid-1980s, Ladenson's lab developed a monoclonal antibody that bound to a form of an enzyme, creatine kinase (CK-MB), that was produced mainly in heart cells. Because they were working with several antibodies at the time, Ladenson asked research associate Vonnie Landt to give them names. Landt, an Arnold Schwarzenegger fan, named the CK-MB antibody Conan, after the Robert E. Howard sword-and-sorcery hero brought to the big screen by Schwarzenegger.
After the antibody was licensed to a number of companies and further developed, it became the standard of care applied in hospitals throughout the developed world. Later, Ladenson's lab developed monoclonal antibodies to Troponin I that provided even more specific heart attack diagnosis. Together, the tests have made the University significant sums of money, at one point providing a fifth of the University's annual technology licensing revenue.
Ladenson has put the money from the heart attack tests to multiple good uses, including the endowment of three faculty chairs at the University: the Oree M. Carroll and Lillian B. Ladenson Professor of Clinical Chemistry, the Conan Professor of Laboratory Medicine and the Ladenson Professor of Pathology.
The funds also have sometimes proven helpful to a second major branch of his life's work that began in 1994. Ladenson still remembers the call he received that year from Heinz Hoenecke, M.D., founder of Pathologists Overseas Inc. When he retired from pathology, Hoenecke, whose parents had been missionaries, decided to cross-train as an internist and go to Africa to serve as a doctor. That trip led to two revelations for Hoenecke, according to Ladenson.
"The first was that he was a lousy internist," Ladenson says. "And he'll tell you that — it's just so easy to like this guy. But the second was that he had seen very, very poor pathology and diagnostic services, and there was a real opportunity for improvement in these areas."
Soon, Ladenson was taking the first of many overseas trips to countries like Eritrea, Kenya and Bhutan to see what he and others could do to help. Among his discoveries: The best way to learn what diagnostic services are most in need is to ask the country's own health-care professionals.
"All of us who guessed what would be the most utilized tests in Eritrea guessed wrong," he says. "It was a very useful lesson: Do not presume you know more than the people in a country just because they happen to be poor and born in an underdeveloped place."
Jack Ladenson
Education: B.S., Pennsylvania State University; Ph.D., University of Maryland at College Park
Family: Wife, Ruth; daughter, Michele, and son-in-law, John Zhong; son, Jeff, and daughter-in-law, Lauren; grandchildren Henry Zhong and Jonas, Elsa and Zella Ladenson.
If a clinical test is needed in Eritrea and the test substance in the patient's sample can survive the logistical challenges imposed by transport from that country, Ladenson has worked out a system to have the test performed at Barnes-Jewish Hospital and interpreted by WUSTL faculty. As testing starts to be performed in the country, Ladenson has developed a network of corporate donors of diagnostic equipment.
"There are companies with hearts," he says. "They're out there. If some initially tell me no, I don't mind. I just keep trying."
In many ways, Ladenson has become an expert recruiter. He has learned how to find and develop relationships with foreign governmental officials who are most willing and able to help improve health care in their countries. And he regularly identifies young, established medical professionals interested in spending weeks or even years overseas.
David Windus, M.D., professor of medicine, has joined Ladenson on several trips to Eritrea and Bhutan. The trips started after a diabetes test became available in Eritrea that had been in use in the United States since the 1960s and '70s.
"They now had access to a test, hemoglobin A1C, which showed there was a problem in diabetes patient management, so what should they do about it?" Ladenson says. "I didn't feel comfortable just throwing my hands up, so I got together this small group that included two diabetes clinicians, diabetes nurses and diabetes educators."
Windus, Jason Goldfeder, M.D., assistant professor of medicine, and the rest of the team went to Eritrea to study how patient management could be improved. The group's efforts blossomed into clinical training courses for physicians and nurses and eventually led to the creation of Eritrea's first certified diabetes nurse practitioners.
"Jack has this remarkable vision for how a small group of dedicated people can advance health care in a developing country," Windus says. "He sees how so many different things fit together: the quality of equipment, the stocking of testing materials, the training of clinicians and the ability of physicians to use the information the labs produce, to name just a few examples."
Windus attributes Ladenson's dedication to a strong egalitarian streak: equal access to good care.
Ladenson speaks with wonder of bringing life-saving tests to Third World nations that are taken for granted in the United States.
"When I first became involved in this work, it was frustrating because 'What can I do?' was the central question," he says. "But now I think we've kind of figured out a general way to approach some of these problems."
Ladenson is interim director of the Division of Laboratory and Genomic Medicine.
The Ladenson family on a ski trip to Keystone, Colo.: (from left) Jack Ladenson; son, Jeff Ladenson; daughter-in-law, Lauren Ladenson; son-in-law, John Zhong; daughter, Michele Ladenson; and wife, Ruth Ladenson.
"Jack is a sophisticated clinical chemist who made a strong commitment to the growth and development of our laboratory and genomic medicine division, which is one of the very best," says Emil R. Unanue, M.D., the Paul and Ellen Lacy Professor and former head of pathology and immunology. "Jack's apparent laissez-faire attitude, which we all enjoy, is combined with effective and accomplished leadership."
Ladenson hopes to step down from the interim directorship soon. He's going to stay active in research and in Pathologists Overseas, but he and his wife, Ruth, recently purchased a house in Vermont where they want to spend some time with their family, friends and dogs.
Ladenson's personal hobbies include collecting old material related to sports and politics. He frequently has a table at national shows.
"I started this years ago as a communications device with my then-teenage son," he says. His son is now busy with other things, but Ladenson has continued it, finding it a great stress release.
His son, Jeff, a specialist in foreign disaster relief, now lives in Morocco with his wife, Lauren, a U.S. foreign service officer, and their three children. His daughter, Michele, a cultural anthropologist, lives in Texas with her husband, John, a pediatric anesthesiologist, and a newborn son.
"We try to stop by Morocco or Texas when we can," Ladenson says. "Ruth and I both enjoy visiting the children and grandchildren as often as possible."
Media Contact Jessica Daues
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redpajama_set_name: RedPajamaCommonCrawl


JSI Tip 2818. Your Windows 2000 laptop switches to low resolution when returning from Hibernate and Standby?
- The screen resolution is set to 1024 X 768 or 800 X 600 resolution.
- The 3D Maze screen saver is configured to run in Full Screen mode after one minute of inactivity.
- In the Power Options tool of Control Panel, the Critical Battery Alarm setting is set to a value that is less than the current battery level. The Alarm Action option is set to When the alarm goes off, the computer will Hibernate or Standby.
- You leave the computer running on battery power and the screen saver is activated.
To fix this problem, don't use the 3D Maze screen saver in Full Screen mode, or use the When the alarm goes off, the computer will Hibernate or Standby value for the Low Battery Alarm setting instead of the Critical Battery Alarm setting.


Commercial grades of kaolin are supplied and transported as dry powder, semi-dry noodle or as liquid slurry. The largest use is in the production of paper, including ensuring the gloss on some grades of paper. It is also used in paint, rubber, detergents & textile industries.
Kaolin is an ancient cosmetic ingredient and produces excellent results when used in facemasks. Kaolin clay is a type of soft white cosmetic clay. In the beauty department, it has been used for facial masks, poultices, soaps, scrubs, deodorants and facial powders.
production of kaolin powder for cosmetics – Grinding Mill China. Surround WP Crop Protectant (25lb) Planet Natura. Made from modified kaolin clay,Surround WP Crop Protectant is sprayed on asOMRI Listed for use in organic production . Know More.
Kaolin has the approximate chemical formula of H 2 Al 2 Si 2 O 8 (H 2 O) and is a white or yellow-white powder that has a slightly oily feel. It is an environmentally benign aluminosilicate mineral 7 that is insoluble in water.
I ordered 5 pounds of kaolin clay. Upon opening the box there was powder all around the inside of the box. I managed to collect 3.5 pounds, but is still waiting on a reply from the company to resolve the issue.
Kaolin is used in paper filler and coatings, in cosmetics, in ceramics as well as ceramic proppants, in addition to many filler or absorbent applications. Pure kaolin is a relatively soft mineral, with a Mohs hardness of 2 – 2.5.
Production Of Kaolin Powder For Cosmetics Centered on customers' needs and aimed for customers' satisfaction, Mechanic Machinery is dedicated to providing best solutions and turnkey projects. Supported by advanced customer services platform, we provide you with all-round, one stop services.
production of kaolin powder for cosmetics; Synthetic Fluorphlogopite As Used in Cosmetics. 1 Tentative Safety Assessment Synthetic Fluorphlogopite As Used in Cosmetics March 16, 2012 All interested persons are provided 60 days from the above dat e to comment on this Tentative Safety Assessment and to.
production of kaolin powder for cosmetics. China Clay / Kaolin – AKJMinchem. Commercial grades of kaolin are supplied and transported as dry powder, ... The largest use is in the production of paper, including ensuring the gloss on some grades of paper. ... China Clay is used in toothpaste, cosmetic and soap industry.


text:
Q: Let $X$ be a normed space and $x_0, x_1 \in X$. Let $l \in (0,1)$ be fixed. Prove, that the sequence $x_{n+1}=l x_{n}+(1-l) x_{n-1}$ converges. I'm trying to prove the following:
Let $(X, ||.||)$ be a normed space and $x_0, x_1 \in X$.  Let $l \in (0,1)$ be a fixed constant. Prove, that the sequence $x_{n+1}=l x_{n}+(1-l) x_{n-1}$ converges.
I started with noting, that because $X$ is a vector space, we know that $x_n\in X$ $\forall n\in \mathbb{N}$.
Now I need to show, that there exists $x\in X$ such that $||x_n - x||\rightarrow 0$ as $n \rightarrow \infty$.
It is clear to me, that the sequence $x_0, x_2, x_4, x_6,\cdots$ is "increasing", the elements are "moving away" from $x_0$ on the line between elements $x_0$ and $x_1$. And, the sequence $x_1, x_3, x_5, x_7,\cdots$ is "decreasing", the elements are "moving away" from $x_1$ towards $x_0$.
Also, I know that the elements of the first subsequence are all "smaller" than the elements in the second subsequence.
So the limit $x$ should be the meeting point of these two subsequences.
PS!
I understand, that there is no smaller or larger, because $x_0, x_1$ can be any two elements in X. I just put them on a number line.

A: I claim that $(x_n)$ is Cauchy.
$$||x_{n+1} - x_n|| = |(l-1)|||x_n - x_{n-1}|| = (l-1)^2 ||x_{n-1} - x_{n-2} || = $$
$$ |l-1|^n||x_1 - x_0|| \to 0$$
Since $|l-1|^n \to 0$.  Now, the elements in this sequence lie in a finite dimensional space (span of $x_1 - x_0$). Since every finite dimensional normed space is complete, and every Cauchy sequence in a complete normed space converges, we get than $x_n \to x$ for some $x \in X$.

A: The recursive relation
$$
x_{n+1}=\ell x_n+(1-\ell)x_{n-1}
$$
implies:
(i) $x_{n+1}-x_n=(\ell-1) (x_n-x_{n-1})\quad\Longrightarrow\quad
x_{n+1}-x_n=(\ell-1)^{n} (x_1-x_{0})$
(ii) $x_{n+1}-(\ell-1) x_n=x_n-(\ell-1)x_{n-1}\quad\Longrightarrow\quad
x_{n+1}-(\ell-1) x_n=x_1-(\ell-1)x_{0}$
Hence
$$
x_{n}=\frac{1}{2-\ell}
\Big(\big(x_1-(\ell-1)x_{0}\big)-(\ell-1)^{n} (x_1-x_{0})\Big)
\to \frac{1}{2-\ell}\big(x_1-(\ell-1)x_{0}\big).
$$
Note that the convergence of this sequence DOES NOT require completeness of the space $X$, i.e. does not have to be a Banach space.

A: The sum of a geometric sequence with common ratio $\vert 1-l \vert <1$ converges.
$$x_n = x_0 + \left(\sum_{k=0}^{n}(1-l)^k\right)(x_1-x_0) \overset{n\to\infty}{\to} x_0 + \frac{1}{l}(x_1-x_0) \in X. $$
I'm not sure this is right, because I haven't mentioned the norm, but I don't see why you have to...

redpajama_set_name: RedPajamaStackExchange


A few news items to share with the neighborhood.
Mary Beth Sitrick of Garfield Street was elected to the HTCA board of directors at the board's March meeting. All seven board positions are now filled. Thank you, and welcome, Mary Beth!
Plans for the Sunday, May 19, neighborhood ice cream social are advancing. We are hoping to get our kids more involved in the event than in years past. To offer ideas or volunteer, please contact Amy Royden-Bloom, the chairwoman of our board's social committee, at amyroyden@hotmail.com.
Please consider renewing your membership to the HTCA. Annual dues are $20. The dues cover the costs of our social events, community meetings, and newsletters. Only dues-paying members are permitted to vote when important issues are put before the community. We expect a court decision on the Suburban Hospital expansion any day, and will be calling a community meeting to discuss the matter shortly thereafter. You can pay by Paypal on the HTCA.net home page, or send a check payable to HTCA to our treasurer, Stephen Brown, 5504 Hoover Street.
We're Connected — Are You?
We are now on Facebook at Huntington Terrace, Bethesda Maryland, and Twitter as htcabethesda. We'll be posting lots of local information and updates, and encourage others to follow suit. It's an excellent way to keep the community connected.


text:
Q: Trying to properly use ReactHook's useState I want to establish some simple validation for my functional React component.  To that end, I'm using ReactHook's useState to instantiate a validationErrors object that is intended to grow like this:
{}
{'fieldName1': 'Some error message'}
{'fieldName1': 'Some error message', 'fieldName2': 'Another error message'}
{'fieldName1': 'Different error message', 'fieldName2': 'Another error message'}

  const [validationErrors, setValidationErrors] = useState(null);

  // If this function is working correctly then it will either add a
  // new key-value pair if the key doesn't exist yet or will update
  // the value if the key already exists.
  const updateValidationErrors = (name, error) => {
    if ([name] in validationErrors) {
      setValidationErrors({...validationErrors, [name]: error});
    } else {
      setValidationErrors({[name]: error, ...validationErrors});
    }
  };

  const checkValidation = (target) => {
    updateValidationErrors('companyName', 'Test Company 1');
    console.log(validationErrors);
    updateValidationErrors('companyName', 'Test Company 2');
    console.log(validationErrors);
    updateValidationErrors('notes', 'Notes error message 1');
    console.log(validationErrors);
    updateValidationErrors('notes', 'Notes error message 2');
    console.log(validationErrors);
    updateValidationErrors('companyName', 'Test Company 3');
    console.log(validationErrors);
  };

I'm getting strange results with the console.log and am wondering if that's because there is a short async delay with ReactHook's useState?
Or is there something wrong with my updateValidationErrors code?
Note: I tested the function here: https://repl.it/repls/WeeklyMustyMiddleware

A: I guess it won't work like this because in
const [validationErrors, setValidationErrors] = useState(null);

setValidationErrors is nothing but the short hand of setState({ validationErrors: <new value> }) which you have mentioned as well.
setState in react is an async call and doesn't guarantee that the value will be updated after the setState line is executed.
Try this to see the updated result
  const [validationErrors, setValidationErrors] = useState();
  const updateValidationErrors = (name, error) => {
    setValidationErrors({...validationErrors, [name]: error});
  };

  const checkValidation = (target) => {
    updateValidationErrors('companyName', 'Test Company 1');
    updateValidationErrors('companyName', 'Test Company 2');
    updateValidationErrors('notes', 'Notes error message 1');
    updateValidationErrors('notes', 'Notes error message 2');
    updateValidationErrors('companyName', 'Test Company 3');
  };

A: react useState is not rective to console
react useState is not rective, then you can do useEffect to console.
And then you will see when validationErrorsupdate.
Add this line to your code
useEffect(() => console.log(validationErrors))

And of course
import React, { useEffect } from 'react';


Volume Trading was formed in 2002 for the purpose of supplying the European kitchen DIY & merchant markets with strategic wood products via their partners in Eastern Europe.
Volume Trading (Europe) Ltd was formed by Barry Dunn and Marcin Balon who have 40+ years combined experience within the wood industry, in particular with worktops, furniture and flooring. The European trading company is UK based, in the North East of England near the ports ( Teesport & Hull) with a Polish administration and sourcing office in Krosno run by Marcin & Barbara Balon. The UK head office is run by Barry Dunn, Managing Director; Mark Richardson, Director General Manager and Barbara Marshall, administration.
with NEPCon Sp. z o.o.
Real wood worktops and real wood shelving is available in multi species and sizes as required. In specified (AB or BC) quality sanded or pre-oiled with WOCA FDA approved worktop oil.
We also offer Silkwood™ finished pre oiled worktops, shelving and hobby boards giving the ultimate quality and the most exceptional finish in the market.
Floating Shelving systems in honeycomb construction and solid form, [MiTable] table systems.
Exclusive supply of real wood parquet "Flooring on the net".
Silkwood™ own brand products including FDA approved treatment oils for flooring.
Wood components for the furniture / building & flooring industry.
Most of the above products can be supplied "Own Branded" and sized to customers' requirements. Because the company is quality focused with several unique products the current growth is in double figures despite the economic downturn.


text:
Briefing Esports
Enthusiast Gaming Plummets After 2021 Earnings Release: $167.4 Million In Revenue, $52.0 Million Net Loss
March 29, 2022 2:20 PM March 29, 2022 11:59 AM ER Velasco 0 Comments Enthusiast Gaming
Enthusiast Gaming (TSX: EGLX) reported on Monday its Q4 and full year 2021 financial results, posting an annual revenue of $167.4 million. This is higher than 2020's revenue of $73.0 million.
However, gross margin declined to 22.6% for the year from last year's 25.6%. Add to this, operating expenses jumped to $85.3 million coming from $35.5 million last year. Salaries and wages, and share-based compensation took the largest slices, amounting to $25.1 million and $18.9 million, respectively.
This led the company to record an annual net loss of $52.0 million compared to net losses of $26.9 million last year. The annual loss translates to $0.43 per share.
"Our momentum continues and we are pleased to confirm our record-breaking results from Q4 2021," said CEO Adrian Montgomery. "We are seeing strong repeat business in direct sales, continued conversions of viewers into paying subscribers, and strength in our product offerings."
Montgomery said the firm expects this trend to continue in 2022 and beyond.
The company's shares took a dive as it opened today, falling by as much as 11.69%.
At the end of the year, the company had $22.7 million in cash coming from a starting balance of $4.3 million at the start of the year. The influx of cash mainly came from net proceeds of share offerings amounting to $95.1 million. The balance of the current assets came in at $59.3 million while current liabilities ended at $68.4 million.
Enthusiast Gaming last traded at $3.85 on the TSX.
Information for this briefing was found via Sedar and Enthusiast Gaming. The author has no securities or affiliations related to this organization. Not a recommendation to buy or sell. Always do additional research and consult a professional before purchasing a security. The author holds no licenses.
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The Animal Shelter is always looking for volunteers to help with fund raisers and the daily operation of the animal shelter. In order to volunteer you must not have been convicted of any crime against animals or children or a crime violent in nature. If you are interested in volunteering, please give us a call or stop by the Animal Shelter today.
Donations are always welcome at the Fitzgerald-Ben Hill County Animal Shelter. The Shelter is a non-profit organization which will take in over 1,500 animals a year. The only way to help support and achieve our goals and accomplish the purposes of this shelter is with generous support and donations from businesses and individuals. Donations are a tax-deductible charitable contribution. If you would like to make a donation or contribution to the Animal Shelter you may do so by visiting the Shelter or giving us a call.
The Fitzgerald-Ben Hill County Humane Society accepts memorials and honorariums at the Animal Shelter. If you'd rather make a charitable donation in memory or honor of a loved one, this is a great way to assist the shelter.


This is a great opportunity for someone with a passion for social media and all things digital to get creative within a leading fitness organisation.
The successful candidate will be active across multi social media channels. You have a track record in implementing social media campaigns across various platforms and a portfolio of working across different brands.
You have a good understanding of how social platforms work, experience of using ads and business manager within Facebook and an understanding of tools such as Pulsar, Sprinklr, Hootsuite, Sprout, etc.
You will be responsible for the delivery and execution of social media and digital marketing strategy to create compelling copy that engages, excites and represents our brand.
The position will involve digital marketing, content development with a focus on SEO, plus researching features and copywriting for digital and print, video editing and podcasts.
The role requires a highly organised, self-motivated digital marketing professional with a high degree of accuracy and the ability to work to often tight production deadlines.
The Digital Marketing Executive will report to the Content and Communications Editor.
Create content for social media channels to include Facebook, Twitter, LinkedIn, web, blogs and other social networking platforms.
Formulate digital marketing strategies with relevant stake holders to drive traffic and engagement through our websites and increase social media following.
Creating high quality content with a consistent brand message to include an online newsletter, blog, print publication, etc.
Develop SEO strategies to enhance optimisation of company websites to ensure strong rankings among top search engines.
Analyse and report on performance of social media and SEO initiatives using Google analytics and assess against objectives.
Set up paid search campaigns - manage and optimise performance of campaigns.
Manage social media budgets and ensure campaign objectives are met.
Generate reports on Google Analytics and recommend actions on insights.
Engage with social media users and respond to any mentions over Twitter, Facebook, etc.
Ensure the house style / tone is woven throughout all copy and communications.
Identify trends and commercial opportunities and implement innovative digital marketing opportunities.
Keep up to date with the latest social media innovations / industry developments and trends.
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text:
Back to Journals » Therapeutics and Clinical Risk Management » Volume 13
Renal safety of tenofovir and/or entecavir in patients with chronic HBV monoinfection
Authors Yang YM, Choi EJ
Received 5 June 2017
Accepted for publication 13 September 2017
Published 26 September 2017 Volume 2017:13 Pages 1273—1285
DOI https://doi.org/10.2147/TCRM.S143286
Editor who approved publication: Professor Garry Walsh
Young-Mo Yang, Eun Joo Choi
Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea
Background: Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are recommended as the first-line therapy for chronic hepatitis B (CHB) due to their genetic barrier to resistance and effectiveness of virological suppression. TDF and ETV may cause renal toxicity through various mechanisms such as renal tubular injury, apoptosis, and mitochondrial toxicity. The aims of the current review were to assess the potential renal toxicity associated with the use of TDF and ETV in patients infected with chronic hepatitis B virus (HBV) and to provide clinical perspectives on these two agents in the treatment of CHB.
Methods: A literature search of clinical studies published in PubMed and posted on ClinicalTrials.gov website was implemented to find studies evaluating the potential renal toxicity of TDF and ETV.
Results: Twenty-one studies were examined in this review. The TDF dose used in the studies was 245 or 300 mg/day and that of ETV was 0.5 or 1 mg/day. Based on the markers of renal function, patients treated with TDF were not more likely to show changes in renal function than those treated with ETV; however, the estimated glomerular filtration rates (eGFRs) of patients receiving TDF tended to be more clearly reduced than those of patients receiving ETV. The eGFRs of patients treated with TDF decreased in a time-dependent manner, whereas those of patients treated with ETV increased or decreased across various time points.
Conclusion: The data shown in this study suggest that use of TDF and ETV could be at least associated with reductions in renal function in patients with chronic HBV infection. However, various risk factors, such as pre-existing renal failure and comorbidities, are also associated with decreased renal function during the treatment of TDF and ETV. Thus, studies of management strategies for HBV-infected patients with these risk factors are necessary in the near future.
Keywords: hepatitis B, tenofovir, entecavir, renal safety
Hepatitis B virus (HBV) infection is considered as one of the most important global public health concerns; this potentially life-threatening infection damages the liver and can contribute to acute and chronic diseases. An estimated 240 million individuals are chronically infected with HBV worldwide, and over 686,000 individuals die annually because of end-stage chronic hepatitis B (CHB) and CHB-associated complications such as decompensated cirrhosis and hepatocellular carcinoma.1
Currently, two therapeutic options (ie, interferons [IFNs] and oral nucleos(t)ide analogs [NUCs]) are used to treat CHB; however, oral NUCs have been preferred for the treatment of CHB owing to their convenient regimen.2 In particular, the second-generation NUCs, such as entecavir (ETV) and tenofovir disoproxil fumarate (TDF), are recommended as the first-line therapy for CHB because of their high genetic barrier to resistance and effectiveness of virological suppression.3,4 The efficacy and safety of both these drugs were demonstrated through previous clinical trials.3 Safety should be particularly considered, since long-term treatment for CHB is usually required with ETV or TDF, although its ideal duration of treatment is not well determined.5
ETV and TDF may cause renal toxicity via various mechanisms such as renal tubular injury, apoptosis, and mitochondrial toxicity.5,6 Previous studies also reported an association between CHB and chronic kidney disease (CKD).7–11 Specifically, it was reported that glomerular diseases, such as membranous nephropathy and mesangiocapillary glomerulonephritis, might be the underlying causes of renal dysfunction in patients with CHB.12,13 Moreover, drug history except for NUCs, disease status of diabetes and/or hypertension (HTN), and baseline (BL) kidney function before starting NUCs may affect the potential nephrotoxicity caused by ETV and/or TDF. Consequently, renal safety is an important factor in choosing appropriate NUCs for the treatment of CHB because they are renally eliminated in an unchanged form, and this is particularly important in patients who have already had renal impairment or are at risk for it.7,14
The current review aimed to assess the potential renal toxicity associated with the use of ETV and TDF in patients infected with chronic HBV and to provide clinical perspectives on these two agents in the treatment of CHB.
A literature search was conducted to identify clinical studies in patients with HBV monoinfection, which assessed the safety of ETV and/or TDF. PubMed was searched from the inception of the database to March 2017, using "hepatitis B," "entecavir," and "tenofovir" as the search terms to find clinical trials written only in English. The reference lists of the selected articles and related reviews were utilized to find additional relevant articles. The data posted on ClinicalTrials.gov website were also used to identify the unpublished clinical outcomes. Two reviewers independently scanned the article titles and abstracts and identified relevant studies that met the following criteria: 1) retrospective or prospective clinical studies, 2) studies involving patients only with HBV infection, 3) studies in which ETV and/or TDF had to be administered for the treatment of HBV infection, and 4) studies whose results contained renal parameters, such as estimated glomerular filtration rate (eGFR), serum creatinine, and serum phosphorus, in order to evaluate the changes in renal function.
Study characteristics
The literature search (Figure 1) identified 21 eligible studies that met the predetermined inclusion criteria. The main characteristics of the selected studies are presented in Table 1. The final eligible studies included in this review were conducted in the United States, Europe, Thailand, Taiwan, Korea, and China.3,15–34 In particular, 13 studies were conducted on Asian individuals.19–23,25–31,34 Most of the studies (61.9%), excluding five randomized clinical studies19,27,29,32,34 and three studies that did not accurately report study designs,24,25,28 were observational studies. Most studies were published in the last 2 years, although the articles dated back to 2011. Overall, 95.2% (20/21) of the studies were conducted on patients with mixed hepatitis B e antigen (HBeAg) status whereas only one study33 did not report HBeAg status. The TDF dose used in the studies was 245 or 300 mg/day and that of ETV was 0.5 or 1 mg/day.
Figure 1 Flowchart of the study selection process.
Abbreviations: ETV, entecavir; HBV, hepatitis B virus; TDF, tenofovir disoproxil fumarate.
Table 1 Main characteristics of included studies
Notes: aThis indicates standard error (SE). bThis indicates median (IQR).
Abbreviations: ADV, adefovir dipivoxil; CHB, chronic hepatitis B; ETV, entecavir; FTC, emtricitabine; F, female; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; IQR, interquartile range; LAM, lamivudine; LdT, telbivudine; M, male; MDR, multidrug-resistant; NR, not reported; SD, standard deviation; TDF, tenofovir disoproxil fumarate; TN, treatment-naïve; TE, treatment-experienced.
Evaluation of renal safety of TDF and ETV
Information bias that may result from broad heterogeneity in the methodology among different studies was the major issue hindering meta-analyses. As presented in Table 2, various parameters were utilized in order to measure renal functions after administering TDF and ETV. The most common parameter used was eGFR calculated using modification of diet in renal disease (MDRD) and Cockcroft–Gault (CG) formulae.
Table 2 Summary of renal safety evaluation provided by included studies
Notes: The change in eGFR was calculated by (2nd year eGFR – baseline eGFR)/baseline eGFR ×100%. Categories of CKD were defined based on eGFR: ≥90, 60–89, 59–30, and <30 mL/min/1.73 m2, respectively. Classification of eGFR is as follows: unimpaired (eGFR >80 mL/min), mildly impaired (50 mL/min ≤ eGFR ≤80 mL/min), moderately impaired (30 mL/min ≤ eGFR <50 mL/min), and severely impaired (eGFR <30 mL/min).
Abbreviations: BL, baseline; CKD-EPI-CysC, Chronic Kidney Disease Epidemiology Collaboration and cystatin C; CKD-EPI-Cr-CysC, Chronic Kidney Disease Epidemiology Collaboration and creatinine plus cystatin C; CG, Cockcroft–Gault; eGFR, estimated glomerular filtration rate; ETV, entecavir; FTC, emtricitabine; IQR, interquartile range; LAM, lamivudine; LdT, telbivudine; MDRD, modification of diet in renal disease; MDRD4, modification of diet in renal disease 4-variable version; MO, month; SD, standard deviation; TDF, tenofovir disoproxil fumarate; TN, treatment-naïve; TE, treatment-experienced.
An observational study comparing long-term renal functions reported eGFR in 424 patients with TDF-containing regimens and 187 patients with ETV according to the MDRD method.15 In the patients with TDF-containing regimens, the mean eGFR decreased from 90.8 mL/min at BL to 85.1 mL/min at 60 months. However, in the patients with ETV, the mean eGFR increased from 81.2 mL/min at BL to 90.7 mL/min at 60 months. A retrospective–prospective cohort study conducted in Taiwan determined a change in eGFR in 37 patients with TDF and 62 patients with ETV based on the MDRD method.20 In the patients with TDF, the mean eGFR changed from 78.3 mL/min/1.73 m2 at BL to 73.0 mL/min/1.73 m2 at 24 months, whereas in the patients with ETV, the mean eGFR increased from 75.6 mL/min/1.73 m2 at BL to 79.3 mL/min/1.73 m2 at 24 months. A similar change in eGFR calculated using the MDRD method was also observed in a retrospective cohort study conducted in Taiwan.23 The mean eGFR in 170 patients with TDF changed from 92 mL/min/1.73 m2 at BL to 86.3 mL/min/1.73 m2 at 24 months; however, in 233 patients with ETV, the mean eGFR changed from 86.1 mL/min/1.73 m2 at BL to 94.4 mL/min/1.73 m2 at 24 months.
A prospective cohort study conducted in Turkey reported a change in eGFR in 44 patients with TDF and 32 patients with ETV according to the Chronic Kidney Disease Epidemiology Collaboration and cystatin C (CKD-EPI-CysC) method.16 The mean eGFR in the patients with TDF decreased from 84.7 mL/min/1.73 m2 at BL to 76.9 mL/min/1.73 m2 at 24 months (p=0.004) and that in the patients with ETV decreased from 90.0 mL/min/1.73 m2 at BL to 84.5 mL/min/1.73 m2 at 24 months (p=0.46). However, the mean values of eGFR in both groups were different when the Chronic Kidney Disease Epidemiology Collaboration and creatinine plus cystatin C (CKD-EPI-Cr-CysC) method was used. The mean eGFR in the patients with TDF changed from 90.6 mL/min/1.73 m2 at BL to 73.6 mL/min/1.73 m2 at 24 months (p=0.05), and the mean eGFR in the patients with ETV changed from 93.5 mL/min/1.73 m2 at BL to 82.3 mL/min/1.73 m2 at 24 months (p=0.17). A study conducted by Koklu et al24 in Turkey reported eGFR calculated using the MDRD method. The mean eGFR in 273 patients with TDF changed from 100.72 mL/min/1.73 m2 at BL to 96.72 mL/min/1.73 m2 at 24 months (p=0.001), whereas the mean eGFR in 282 patients with ETV changed from 96.20 mL/min/1.73 m2 at BL to 95.94 mL/min/1.73 m2 at 24 months (p=0.535). In a study conducted by Hung et al28 in Taiwan, TDF and ETV showed decreased mean eGFR calculated using the MDRD method. The mean eGFR in 41 patients with TDF changed from 108 to 87 mL/min/1.73 m2 at 6 months (p=0.001), and the mean eGFR in 148 patients with ETV changed from 92 to 84 mL/min/1.73 m2 at 6 months (p=0.001).
Close attention should be paid to the safety and efficacy of TDV and ETV for the long-term treatment of chronic HBV infection, because they are currently the most potent antiviral agents for treating HBV infection.3,5 TDF and ETV are likely to cause renal toxicity through various mechanisms including renal tubular injury, apoptosis, and mitochondrial toxicity.5,6 The present study reviewed the literature and provided a comprehensive summary of the renal safety of TDF and ETV for the treatment of patients with chronic HBV infection. The results based on the studies reviewed in this article indicated that TDF and ETV could be responsible at least for reduced kidney function in patients with chronic HBV infection.
In this study, the effects of TDF and ETV on renal function were assessed. Based on the markers of renal function, compared to patients treated with ETV, those treated with TDF were not more likely to show changes in renal function, although the eGFR of patients treated with TDF tended to be more clearly reduced than that of patients receiving ETV. The eGFRs of patients treated with TDF decreased in a time-dependent manner, whereas those of patients treated with ETV increased or decreased across various time points.15,16,20,23,24,28 Similar percentage of patients in both the treatment groups showed ≥20% decrease in eGFR during the treatment (based on CG, TDF 35.0% vs ETV 36.3%; based on MDRD, TDF 41.3% vs ETV 43.8%).33 A similar tendency was also observed in a recent clinical trial conducted in Thailand.19 After 36 months, 16.8% and 14.9% of patients receiving TDF and ETV, respectively, experienced ≥20% decrease in eGFR; however, the decrease was observed in more patients receiving TDF than in those receiving ETV at 12 and 24 months.19 Around 30% of patients in both TDF and ETV groups experienced a ≥0.2 mg/dL increase in creatinine from BL; however, creatinine increase of ≥0.5 mg/dL from BL occurred in more patients receiving ETV than in those receiving TDF (13.8% vs 3.8%; p=0.025).33 The frequencies of creatinine elevation by ≥0.3 mg/dL were similar in both groups (TDF/ETV 2.0% vs ETV 3.3%); however, creatinine elevation by ≥0.5 mg/dL was more frequent in patients treated with ETV alone (TDF/ETV 0.0% vs ETV 1.6%).32 These heterogeneous results may be partially attributed to different characteristics, such as comorbidities and co-administered drugs, of the study subjects.
According to multivariate analyses, various risk factors, such as advanced age, preexisting renal failure, comorbidities, history of transplant, concomitant nephrotoxic drugs, advanced HIV coinfection, and male gender, were associated with eGFR reductions by TDF or ETV.23,26,33,35,36 Especially, preexisting renal insufficiency was a major independent risk factor for deterioration of renal function during the treatment of chronic HBV infection.23,26,33 Moreover, previous studies have reported an association of CHB with CKD, and ~15%–30% of patients with CHB showed BL renal insufficiency or comorbidities that were likely to cause CKD, such as diabetes mellitus (DM) and HTN.7–11 However, TDF therapy was not significantly associated with changes in renal function when compared with ETV therapy.26,33 Large proportions of TDF and ETV are also renally excreted in their unchanged forms.37,38 Thus, NUCs other than TDF and ETV may be considered to prevent the progression of renal decline in patients with CHB and decreased renal functions.
Compared with TDF, tenofovir alafenamide (TAF), a novel prodrug of tenofovir, led to approximately four times higher intracellular concentrations of tenofovir diphosphate, an active metabolite, which may result in much lower doses of TAF than those of TDF.39,40 Consequently, ~90% lower systemic exposure of tenofovir was expected in patients treated with TAF than in those treated with TDF.40 This is likely to reduce the risk for tenofovir-associated renal toxicity. According to a clinical trial conducted in patients infected with HIV-1, decreases or slight increases from BL to Week 48 in total urinary protein, albumin, retinol-binding protein, and β2-microglobulin to urine creatinine ratios were observed in the TAF group; however, increases from BL to Week 48 in the protein to urine creatinine ratios were reported in the TDF group.40 Two recent randomized clinical trials conducted in patients with HBeAg-negative or -positive chronic HBV infection reported that TAF not only was non-inferior to TDF but also improved the negative effect of tenofovir on renal function.41,42 In patients with HBeAg-negative chronic HBV infection, a small mean increase in creatinine from BL to Week 48 was reported in both TAF and TDF groups, and at Week 48, a median decrease in eGFR by CG was lower in patients treated with TAF than in those treated with TDF.41 Significantly smaller increases from BL to Week 48 in the markers of proximal tubular dysfunction, retinol-binding protein, and β2-microglobulin to urine creatinine ratios were noted in the TAF group than in the TDF group.41 Similar tendencies were observed in patients with HBeAg-positive chronic HBV infection.42 A network meta-analysis conducted by Chan et al7 reported that telbivudine (LdT) consistently improved renal functions measured by eGFR independent of measuring methods. In particular, tenofovir monotherapy caused decreases in eGFR, but combinational therapy of tenofovir with LdT improved renal functions.7
According to the WHO guidelines for the treatment of CHB in 2015, measuring BL renal function and assessing BL risks for renal dysfunction are recommended before commencing antiviral therapy.43 In cases where BL patients have eGFR <50 mL/min or risk factors for renal insufficiency, such as long-term DM, uncontrolled HTN, and severe bone-related diseases, tenofovir should be avoided, its dose should be adjusted, or ETV should be used.43 Thus, as shown in previous randomized clinical studies,40,41 TAF could be considered as the first drug of choice for the treatment of CHB in patients with reduced renal function or in those with risk factors for renal dysfunction. In addition, LdT monotherapy or combinational therapy with TAF could be another option for these patients; however, well-organized, randomized clinical trials are necessary to prove renal safety when TAF + LdT or LdT alone is administered to these patients.
This study had some limitations that should be addressed. Two electronic databases (ie, PubMed and ClinicalTrials.gov website) were utilized to search relevant clinical trials, although various databases are available. This limited database utilization also likely limited our opportunities to search additional valuable and relevant clinical trials. Almost all of the selected clinical trials mentioned that TDF and ETV were not likely to have significantly negative effects on renal functions. However, consistent results were not shown partially owing to the different characteristics of study subjects and various markers used to measure renal functions, which made the conducting of further meta-analysis difficult.
The data reported in this study suggest that use of TDF and ETV could be associated with reductions in kidney function in patients with chronic HBV infection. The eGFRs of patients treated with TDF were reduced in a time-dependent manner, whereas the eGFRs of patients treated with ETV increased or decreased across various time points. TAF as the first drug of choice for the treatment of chronic HBV infection could be used in patients with decreased renal function or in those with risk factors for renal dysfunction, and TAF + LdT or LdT alone could also be considered for these patients. However, well-organized, prospective, large-scale, randomized clinical trials are necessary to determine the renal safety of TAF + LdT or LdT alone for the treatment of such patients. In addition, studies on management strategies for HBV-infected patients with various risk factors (eg, advanced age, pre-existing renal failure, comorbidities, history of transplant, and concomitant nephrotoxic drugs) associated with reduction in eGFR are warranted in the near future.
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (No 2016R1C1B1015938).
The authors report no conflicts of interest in this work.
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EDINA's annual Geoforum conference for all its geospatial services and projects was held at the University of Edinburgh's Institute of Geography this year. It was attended by nearly 50 delegates who came to find out what we have been up to over the past year and to see what we new things they can expect in the coming months.
Guy's talk highlighted the main changes to EDINA's geospatial offering in the last 12 months. We have mainly been working on things that you can't "see" in Digimap with huge improvements to the way the service is delivered. We now can make sure that interruptions to the service are rare as it can be delivered from one of two physical locations at the University of Edinburgh.
One obvious change we delivered was the improved Digimap home page. This came about through work to make the service usable on a touch screen or tablet device. To ensure that the service could work on these devices we needed to use new web technologies meaning a redesign had to be carried out. We like the cleaner design but best of all you can now just click on the application you want to use, log in when prompted, and be taken straight to the thing you want to do. No more remembering to log in to the service before clicking the link in your Data Download email!
The next two talks were all about Aerial Imagery as EDINA will soon be launching the Aerial Digimap service. The new service will contain 25cm resolution aerial photographs for the whole of Great Britain from Getmapping.
Firstly we head from Richard Evans from Getmapping who spoke about the history of aerial imagery and also the modern technology and techniques that go in to it's creation.
Then we heard from Ian Holmes from EDINA, who showed us what the new Digimap Aerial collection would look like. As with the other Digimap collections there will be Roam and Download interfaces to either view the data or to take it away to analyse in the user's own software.
Ian also highlighted some of the interesting and quirky things captured in the images, such as the shadows of giraffes at Chester Zoo.
Please keep watching the blog and other Digimap information channels for an announcement on when the service will be launching.
After a good lunch spent networking we started on the afternoon session where we heard from two students and two members of teaching staff about their uses of Digimap and data from the services.
Firstly we heard from Trevor Draeseke who told us about his Masters Thesis, Visualising Geographical Information in Augmented Reality.
Next we heard from Kathy O'Donnell who is now in the first year of a PhD that is building on her MSc thesis on the Quarries of Hadrian's Wall.
Kathy has been mixing layers from the various data collections in Digimap: Ordnance Survey, Historic and Geology, to identify where the Romans were quarrying the stone to build Hadrian's Wall. Kathy's work is one of the best examples of making use of the various collections we have seen and she is looking forward to hopefully being able to use Aerial Digimap as another important source of data.
Despite showing how important Digimap is and has been in studying and teaching all four of the presentations contained mentions of what they'd like to see in the future and a final challenge from Duncan to stay relevant in a world with an increasing amount of alternatives. We have heard this challenge and are working with those who fund the service to make sure our offering stays up-to-date and continues to deliver what academia wants. However we would like to remind all users of Digimap to keep letting us know what you want from the service so we have enough evidence to shape future developments in the right way.
A final thank you to all those who gave a presentation, the Institute of Geography for providing a venue, and to all the attendees; we felt it was a very successful event and look forward to the next one in 2017.


The course I will examine as an example is that of Pulmonary Function Testing. This is a mandatory course within the Respiratory Therapy program. It was also taught be me last year between September and November, 2018.
What are the intended learning outcomes of the course?
Do the learning outcomes reflect high-level cognitive skills or low-level skills (pay attention to the verbs)?
– Analyze, apply, and interpret reflect higher-level cognitive skills. Perform reflects lower-level. Understand is more difficult to easily categorize, as I would argue it is vague and could be interpreted different ways. Robert may interpret it as memorizing or describing, where as Susan may perceive it as explaining or reflecting. If I had to decide I would categorize understand as a lower-level skill.
How is student learning assessed in the course (essays, quizzes, journals, machine-gradable tests, portfolios)?
In what ways are the intended learning outcomes and the assessments aligned or not?
– Alignment would very much depend on the type of questions being asked. If the majority of questions only challenged lower-level skills then there would be mis-alignment. For example if the teacher wanted students to apply but asked questions where one could easily answer if one memorized the key points.
Identify 2-3 items or assessments that are worded in such a way that they limit students to a unistructural or multistructural response at best and re-write them so that they require a relational response at worst and include the results in your post.
Compare and contrast between high and low levels of quality control (QC) in pulmonary function (PF) testing, and apply QC on PF equipment in the lab.
Justify the purpose of various PF tests and apply each in the diagnosing of particular lung diseases.