Fractionation of Methane Isotopologues during Preparation for Analysis from Ambient Air.

Preconcentration of methane (CH4) from air is a critical sampling step in the measurement of singly and doubly substituted isotopologue ratios. We demonstrate the potential for isotope fractionation during preconcentration onto and elution from the common trapping material HayeSep-D and investigate its significance in laser spectroscopy measurements. By altering the trapping temperature for adsorption, the flow direction of CH4 through the trap and the time at which CH4 is eluted during a desorption temperature ramp, we explain the mechanisms behind fractionation affecting δ13C(CH4) and δ2H(CH4). The results highlight that carbon isotope fractionation is driven by advection and diffusion, while hydrogen isotope fractionation is driven by the interaction of CH4 with the adsorbing material (tending to smaller isotopic effects at higher temperatures). We have compared the difference between the measured isotope ratio of sample gases (compressed whole air and a synthetic mixture of CH4 at ambient amount fraction in an N2 matrix) and their known isotopic composition. An open-system Rayleigh model is used to quantify the magnitude of isotopic fractionation affecting measured δ13C(CH4) and δ2H(CH4), which can be used to calculate the possible magnitude of isotopic fractionation given the recovery percentage. These results provide a quantitative understanding of isotopic fractionation during the sample preparation of CH4 from ambient air. The results also provide valuable insights applicable to other cryogenic preconcentration systems, such as those for measurements that probe the distribution of rarer isotopologues.

Step Change in Improving the Accuracy of Nitrous Oxide Reference Materials for Underpinning Atmospheric Composition Measurements.

We have employed a new approach to quantify the amount fraction of nitrous oxide in a synthetic air matrix gas used to prepare high-accuracy reference materials of the same component. Until now, this was the largest contributor to the measurement uncertainty of nitrous oxide in air reference materials at atmospheric amount fractions (∼330 nmol mol-1), as identified in a recent international comparison. A novel preconcentration method has resulted in a measurement of 363 pmol mol-1 of nitrous oxide in a synthetic air matrix gas with an expanded uncertainty of 27 pmol mol-1. This represents a significant breakthrough as using these developments with an optimized dilution hierarchy (to minimize the gravimetric uncertainty) promises to result in SI traceable reference materials with expanded uncertainties as low as 0.032% relative (k = 2). This supports the World Meteorological Organization-Global Atmosphere Watch network compatibility goal for underpinning atmospheric observations.

Methods and Lessons Learned from a Current State Workflow Assessment following Transition to a New Electronic Health Record System.

The transition to a new electronic health record (EHR) system requires an understanding of how the new system addresses the needs, business processes, and current activities of a healthcare system. To address such requirements, a multidisciplinary team conducted a current state workflow assessment (CSWFA) of clinical and administrative functions to elicit and document business processes (via process diagrams), requirements, workarounds, and process issues (i.e., user interface issues, training gaps) at one healthcare facility. We provided a novel method of evaluating the implementation process to ensure that a CSWFA was documented with key stakeholders. In this analysis, we describe the CSWFA approach and expected outcomes with a specific emphasis on how a qualitative approach can be integrated to explore underlying patterns and relationships in the data. Overall, this methodology enables practitioners to deliver data-driven support initiatives that optimize EHR implementation while considering user experience, productivity, and patient safety.

[Emergency thoracotomy in a severely injured patient after hemorrhagic shock in traumatic pelvic bleeding : Case report]. / Notfallthorakotomie nach hämorrhagischem Schock bei traumatischer pelviner Blutung bei Schwerstverletztem : Fallbericht.

A case of in-hospital thoracotomy with subsequent open chest cardiopulmonary resuscitation of a polytraumatized patient is reported. Emergency thoracotomies are rare interventions in challenging situations. Up to now there are only few standards or uniform education and training concepts. The indications are often a borderline decision. The aim of thoracotomy and open resuscitation in combination with a reduction in circulation, for example by cross-clamping the aorta, is to save time to address reversible causes of the hemorrhage, redirect the blood volume into the vital cerebral and coronary circulation and minimize bleeding from subdiaphragmatic bleeding sources. Ultimately, in case of doubt, the thoracotomy can be performed for the patient's benefit with the appropriate indications.

Boreas: A Sample Preparation-Coupled Laser Spectrometer System for Simultaneous High-Precision In Situ Analysis of δ13C and δ2H from Ambient Air Methane.

We present a new instrument, "Boreas", a cryogen-free methane (CH4) preconcentration system coupled to a dual-laser spectrometer for making simultaneous measurements of δ13C(CH4) and δ2H(CH4) in ambient air. Excluding isotope ratio scale uncertainty, we estimate a typical standard measurement uncertainty for an ambient air sample of 0.07‰ for δ13C(CH4) and 0.9‰ for δ2H(CH4), which are the lowest reported for a laser spectroscopy-based system and comparable to isotope ratio mass spectrometry. We trap CH4 (∼1.9 µmol mol-1) from ∼5 L of air onto the front end of a packed column, subsequently separating CH4 from interferences using a controlled temperature ramp with nitrogen (N2) as the carrier gas, before eluting CH4 at ∼550 µmol mol-1. This processed sample is then delivered to an infrared laser spectrometer for measuring the amount fractions of 12CH4, 13CH4, and 12CH3D isotopologues. We calibrate the instrument using a set of gravimetrically prepared amount fraction primary reference materials directly into the laser spectrometer that span a range of 500-626 µmol mol-1 (CH4 in N2) made from a single pure CH4 source that has been isotopically characterized for δ13C(CH4) by IRMS. Under the principle of identical treatment, a compressed ambient air sample is used as a working standard and measured between air samples, from which a final calibrated isotope ratio is calculated. Finally, we make automated measurements of both δ13C(CH4) and δ2H(CH4) in over 200 ambient air samples and demonstrate the application of Boreas for deployment to atmospheric monitoring sites.

Use of Hemoadsorption in Patients With Severe Intoxication Requiring Extracorporeal Cardiopulmonary Support-A Case Series.

Drugs intoxications often lead to severe vasoplegia and cardiogenic shock, and VA-ECMO represents a viable therapy option. However, as cardiopulmonary support is not contributing to the removal of the causal agent from the blood, detoxification by a new hemoadsorption device (CytoSorb) could represent a potential therapeutic tool due to its highly efficient elimination capacity of endogenous but also exogenous hydrophobic substances for which otherwise no effective antidote exist. In this case series, four anecdotal cases of acute intoxications requiring VA-ECMO support used as extracorporeal cardiopulmonary resuscitation after intoxication-induced out-of-hospital cardiac arrest (OHCA) are presented, who were additionally treated with CytoSorb hemoadsorption in combination with renal replacement therapy. Combined treatment was associated with a considerable decrease in plasma levels of the overdosed drugs. Additionally, the combination of applied techniques was safe, practical, and technically feasible with no adverse or any device-related side effects documented during or after the treatment sessions. Based on the reported dramatic decline in drug levels during treatment, that fits in the device's characteristics, we strongly suggest to further investigate the potentially lifesaving role of CytoSorb therapy in patients with acute intoxications requiring multiple organ support techniques.

The application of unsupervised deep learning in predictive models using electronic health records.

BACKGROUND: The main goal of this study is to explore the use of features representing patient-level electronic health record (EHR) data, generated by the unsupervised deep learning algorithm autoencoder, in predictive modeling. Since autoencoder features are unsupervised, this paper focuses on their general lower-dimensional representation of EHR information in a wide variety of predictive tasks. METHODS: We compare the model with autoencoder features to traditional models: logistic model with least absolute shrinkage and selection operator (LASSO) and Random Forest algorithm. In addition, we include a predictive model using a small subset of response-specific variables (Simple Reg) and a model combining these variables with features from autoencoder (Enhanced Reg). We performed the study first on simulated data that mimics real world EHR data and then on actual EHR data from eight Advocate hospitals. RESULTS: On simulated data with incorrect categories and missing data, the precision for autoencoder is 24.16% when fixing recall at 0.7, which is higher than Random Forest (23.61%) and lower than LASSO (25.32%). The precision is 20.92% in Simple Reg and improves to 24.89% in Enhanced Reg. When using real EHR data to predict the 30-day readmission rate, the precision of autoencoder is 19.04%, which again is higher than Random Forest (18.48%) and lower than LASSO (19.70%). The precisions for Simple Reg and Enhanced Reg are 18.70 and 19.69% respectively. That is, Enhanced Reg can have competitive prediction performance compared to LASSO. In addition, results show that Enhanced Reg usually relies on fewer features under the setting of simulations of this paper. CONCLUSIONS: We conclude that autoencoder can create useful features representing the entire space of EHR data and which are applicable to a wide array of predictive tasks. Together with important response-specific predictors, we can derive efficient and robust predictive models with less labor in data extraction and model training.

Assessment of unintended volume loss of six closed system transfer devices.

INTRODUCTION: Closed system transfer devices (CSTDs) are used to prepare and administer hazardous drugs. Previous studies have explored the vapor and fluid containment performance of CSTDs. A less obvious consideration is the effect of CSTD use on the intended dose for small volume administrations. We assessed six CSTDs to determine if they contribute to volume loss and delivery of less than the intended dose during simulated drug administration. METHODS: Using an analytical balance, we obtained the mass of each CSTD at four points during simulated drug preparation and subcutaneous administration using sterile water. We used the masses to determine the average volume loss (VL) for each CSTD. RESULTS: Using ANOVA, we identified significant differences in volume loss (VL) among the mean VL (F(6,59) = 18.45, p = 6.19 × 10-12) for the six CSTDs and control (no CSTD). Four CSTDs had a VL that was statistically different than the control (p < 0.05); the VL for two CSTDs was not statistically different than the control (p > 0.05). Volume loss did not depend on administration volume. CONCLUSION: Volume loss performance varied among CSTDs. Volume loss may be clinically significant for small volumes but is not likely clinically significant for larger volumes. It is the authors' opinion that 3 mL represents a reasonable administration threshold below which volume loss should be considered clinically significant. Users should consider volume loss in context of the tasks, drugs, users, and environments where CSTDs will be used. The United States Pharmacopeia (USP) General Chapter <800>: Hazardous Drugs-Handling in Healthcare Settings recognizes the lack of CSTD performance standards. USP <800> recommends independent performance evaluation of CSTDs based on peer-reviewed studies. Our study adds to the comparative performance evaluations of CSTDs available on the market at the time of this review.

The association between outpatient follow-up visits and all-cause non-elective 30-day readmissions: A retrospective observational cohort study.

BACKGROUND: As an effort to reduce hospital readmissions, early follow-up visits were recommended by the Society of Hospital Medicine. However, published literature on the effect of follow-up visits is limited with mixed conclusions. Our goal here is to fully explore the relationship between follow-up visits and the all-cause non-elective 30-day readmission rate (RR) after adjusting for confounders. METHODS AND RESULTS: To conduct this retrospective observational study, we extracted data for 55,378 adult inpatients from Advocate Health Care, a large, multi-hospital system serving a diverse population in a major metropolitan area. These patients were discharged to Home or Home with Home Health services between June 1, 2013 and April 30, 2015. Our findings from time-dependent Cox proportional hazard models showed that follow-up visits were significantly associated with a reduced RR (adjusted hazard ratio: 0.86; 95% CI: 0.82-0.91), but in a complicated way because the interaction between follow-up visits and a readmission risk score was significant with p-value < 0.001. Our analysis using logistic models on an adjusted data set confirmed the above findings with the following additional results. First, time matter. Follow-up visits within 2 days were associated with the greatest reduction in RR (adjusted odds ratio: 0.72; 95% CI: 0.63-0.83). Visits beyond 2 days were also associated with a reduction in RR, but the strength of the effect decreased as the time between discharge and follow-up visit increased. Second, the strength of such association varied for patients with different readmission risk scores. Patients with a risk score of 0.113, high but not extremely high risk, had the greatest reduction in RR from follow-up visits. Patients with an extremely high risk score (> 0.334) saw no RR reduction from follow-up visits. Third, a patient was much more likely to have a 2-day follow-up visit if that visit was scheduled before the patient was discharged from the hospital (30% versus < 5%). CONCLUSIONS: Follow-up visits are associated with a reduction in readmission risk. The timing of follow-up visits can be important: beyond two days, the earlier, the better. The effect of follow-up visits is more significant for patients with a high but not extremely high risk of readmission.

Reconciling reported and unreported HFC emissions with atmospheric observations.

We infer global and regional emissions of five of the most abundant hydrofluorocarbons (HFCs) using atmospheric measurements from the Advanced Global Atmospheric Gases Experiment and the National Institute for Environmental Studies, Japan, networks. We find that the total CO2-equivalent emissions of the five HFCs from countries that are required to provide detailed, annual reports to the United Nations Framework Convention on Climate Change (UNFCCC) increased from 198 (175-221) Tg-CO2-eq ⋅ y(-1) in 2007 to 275 (246-304) Tg-CO2-eq ⋅ y(-1) in 2012. These global warming potential-weighted aggregated emissions agree well with those reported to the UNFCCC throughout this period and indicate that the gap between reported emissions and global HFC emissions derived from atmospheric trends is almost entirely due to emissions from nonreporting countries. However, our measurement-based estimates of individual HFC species suggest that emissions, from reporting countries, of the most abundant HFC, HFC-134a, were only 79% (63-95%) of the UNFCCC inventory total, while other HFC emissions were significantly greater than the reported values. These results suggest that there are inaccuracies in the reporting methods for individual HFCs, which appear to cancel when aggregated together.

Nitrogen trifluoride global emissions estimated from updated atmospheric measurements.

Nitrogen trifluoride (NF(3)) has potential to make a growing contribution to the Earth's radiative budget; however, our understanding of its atmospheric burden and emission rates has been limited. Based on a revision of our previous calibration and using an expanded set of atmospheric measurements together with an atmospheric model and inverse method, we estimate that the global emissions of NF(3) in 2011 were 1.18 ± 0.21 Gg⋅y(-1), or ∼20 Tg CO(2)-eq⋅y(-1) (carbon dioxide equivalent emissions based on a 100-y global warming potential of 16,600 for NF(3)). The 2011 global mean tropospheric dry air mole fraction was 0.86 ± 0.04 parts per trillion, resulting from an average emissions growth rate of 0.09 Gg⋅y(-2) over the prior decade. In terms of CO(2) equivalents, current NF(3) emissions represent between 17% and 36% of the emissions of other long-lived fluorinated compounds from electronics manufacture. We also estimate that the emissions benefit of using NF(3) over hexafluoroethane (C(2)F(6)) in electronics manufacture is significant-emissions of between 53 and 220 Tg CO(2)-eq⋅y(-1) were avoided during 2011. Despite these savings, total NF(3) emissions, currently ∼10% of production, are still significantly larger than expected assuming global implementation of ideal industrial practices. As such, there is a continuing need for improvements in NF(3) emissions reduction strategies to keep pace with its increasing use and to slow its rising contribution to anthropogenic climate forcing.

Automated measurement of nitrogen trifluoride in ambient air.

We present an analytical method for the in situ measurement of atmospheric nitrogen trifluoride (NF(3)), an anthropogenic gas with a 100-year global warming potential of over 16,000. This potent greenhouse gas has a rising atmospheric abundance due to its emission from a growing number of manufacturing processes and an expanding end-use market. Here we present a modified version of the "Medusa" preconcentration gas chromatography/mass spectrometry (GC/MS) system of Miller, B. R.; Weiss, R. F.; Salameh, P. K.; Tanhua, T.; Greally, B. R.; Mühle, J.; Simmonds, P. G. Anal. Chem.2008, 80 (5), 1536-1545. By altering the techniques of gas separation and chromatography after initial preconcentration, we are now able to make atmospheric measurements of NF(3) with relative precision <2% (1σ) for current background clean air samples. Importantly, this method augments the currently operational Medusa system, so that the quality of data for species already being measured is not compromised and NF(3) is measured from the same preconcentrated sample. We present the first in situ measurements of NF(3) from La Jolla, California made 11 times daily, illustrating how global deployment of this technique within the AGAGE (Advanced Global Atmospheric Gases Experiment) network could facilitate estimation of global and regional NF(3) emissions over the coming years.

Emissions of halogenated compounds in East Asia determined from measurements at Jeju Island, Korea.

High-frequency in situ measurements at Gosan (Jeju Island, Korea) during November 2007 to December 2008 have been combined with interspecies correlation analysis to estimate national emissions of halogenated compounds (HCs) in East Asia, including the chlorofluorocarbons (CFCs), halons, hydrochlorofluorocarbons (HCFCs), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), sulfur hexafluoride (SF(6)), and other chlorinated and brominated compounds. Our results suggest that overall China is the dominant emitter of HCs in East Asia, however significant emissions are also found in South Korea, Japan and Taiwan for HFC-134a, HFC-143a, C(2)F(6), SF(6), CH(3)CCl(3), and HFC-365mfc. The combined emissions of CFCs, halon-1211, HCFCs, HFCs, PFCs, and SF(6) from all four countries in 2008 are 25.3, 1.6, 135, 42.6, 3.6, and 2.0 kt/a, respectively. They account for approximately 15%, 26%, 29%, 16%, 32%, and 26.5% of global emissions, respectively. Our results show signs that Japan has successfully phased out CFCs and HCFCs in compliance with the Montreal Protocol (MP), Korea has started transitioning from HCFCs to HFCs, while China still significantly consumes HCFCs. Taiwan, while not directly regulated under the MP, is shown to have adapted the use of HFCs. Combined analysis of emission rates and the interspecies correlation matrix presented in this study proves to be a powerful tool for monitoring and diagnosing changes in consumption of HCs in East Asia.

Effect of obesity on plasma clusterin, [corrected] a proposed modulator of leptin action.

Clusterin, a protein constituent of HDL, was recently shown to bind plasma leptin in vitro and has been proposed to modulate leptin activity. To gain insight into a possible role for plasma clusterin in human obesity, we measured plasma clusterin, leptin, soluble leptin receptor (sObR), and lipoproteins in 70 obese adolescents (12.4 ± 1.6 y; BMI-SD score (SDS-BMI) 2.35 ± 0.47) before and after 3 wk of weight reduction in a dietary camp and in 44 normal weight controls. Binding of plasma leptin to HDL or clusterin was studied using ultracentrifugation and immunoaffinity chromatography. During weight reduction, clusterin decreased from 14.6 ± 4.1 to 10.3 ± 2.9 mg/dL, p < 0.001) in obese adolescents, whereas sObR increased. However, baseline plasma clusterin in obese adolescents did not differ from controls. Clusterin did not correlate with SDS-BMI, weight loss, leptin, or lipoproteins. Only ∼ 1% of plasma leptin was associated with clusterin/apoA-I complexes or with HDL. Our results do not support a role for plasma clusterin as an important leptin-binding protein or modulator of leptin action. The decrease of plasma clusterin during weight reduction may be an effect of the hypocaloric diet rather than being directly linked to weight loss.

Measurement of zinc stable isotope ratios in biogeochemical matrices by double-spike MC-ICPMS and determination of the isotope ratio pool available for plants from soil.

Analysis of naturally occurring isotopic variations is a promising tool for investigating Zn transport and cycling in geological and biological settings. Here, we present the recently installed double-spike (DS) technique at the MAGIC laboratories at Imperial College London. The procedure improves on previous published DS methods in terms of ease of measurement and precisions obtained. The analytical method involves addition of a (64)Zn-(67)Zn double-spike to the samples prior to digestion, separation of Zn from the sample matrix by ion exchange chromatography, and isotopic analysis by multiple-collector inductively coupled plasma mass spectrometry. The accuracy and reproducibility of the method were validated by analyses of several in-house and international elemental reference materials. Multiple analyses of pure Zn standard solutions consistently yielded a reproducibility of about ±0.05‰ (2 SD) for δ(66)Zn, and comparable precisions were obtained for analyses of geological and biological materials. Highly fractionated Zn standards analyzed by DS and standard sample bracketing yield slightly varying results, which probably originate from repetitive fractionation events during manufacture of the standards. However, the δ(66)Zn values (all reported relative to JMC Lyon Zn) for two less fractionated in-house Zn standard solutions, Imperial Zn (0.10 ± 0.08‰: 2 SD) and London Zn (0.08 ± 0.04‰), are within uncertainties to data reported with different mass spectrometric techniques and instruments. Two standard reference materials, blend ore BCR 027 and ryegrass BCR 281, were also measured, and the δ(66)Zn were found to be 0.25 ± 0.06‰ (2 SD) and 0.40 ± 0.09‰, respectively. Taken together, these standard measurements ascertain that the double-spike methodology is suitable for accurate and precise Zn isotope analyses of a wide range of natural samples. The newly installed technique was consequently applied to soil samples and soil leachates to investigate the isotopic signature of plant available Zn. We find that the isotopic composition is heavier than the residual, indicating the presence of loosely bound Zn deposited by atmospheric pollution, which is readily available to plants.

Evidence for the mechanisms of zinc uptake by rice using isotope fractionation.

In an earlier study, we found that rice (Oryza sativa) grown in nutrient solution well-supplied with Zn preferentially took up light (64)Zn over (66)Zn, probably as a result of kinetic fractionation in membrane transport processes. Here, we measure isotope fractionation by rice in a submerged Zn-deficient soil with and without Zn fertilizer. We grew the same genotype as in the nutrient solution study plus low-Zn tolerant and intolerant lines from a recombinant inbred population. In contrast to the nutrient solution, in soil with Zn fertilizer we found little or heavy isotopic enrichment in the plants relative to plant-available Zn in the soil, and in soil without Zn fertilizer we found consistently heavy enrichment, particularly in the low-Zn tolerant line. These observations are only explicable by complexation of Zn by a complexing agent released from the roots and uptake of the complexed Zn by specific root transporters. We show with a mathematical model that, for realistic rates of secretion of the phytosiderophore deoxymugineic acid (DMA) by rice, and realistic parameters for the Zn-solubilizing effect of DMA in soil, solubilization and uptake by this mechanism is necessary and sufficient to account for the measured Zn uptake and the differences between genotypes.

Accurate and precise zinc isotope ratio measurements in urban aerosols.

We developed an analytical method and constrained procedural boundary conditions that enable accurate and precise Zn isotope ratio measurements in urban aerosols. We also demonstrate the potential of this new isotope system for air pollutant source tracing. The procedural blank is around 5 ng and significantly lower than published methods due to a tailored ion chromatographic separation. Accurate mass bias correction using external correction with Cu is limited to Zn sample content of approximately 50 ng due to the combined effect of blank contribution of Cu and Zn from the ion exchange procedure and the need to maintain a Cu/Zn ratio of approximately 1. Mass bias is corrected for by applying the common analyte internal standardization method approach. Comparison with other mass bias correction methods demonstrates the accuracy of the method. The average precision of delta(66)Zn determinations in aerosols is around 0.05 per thousand per atomic mass unit. The method was tested on aerosols collected in Sao Paulo City, Brazil. The measurements reveal significant variations in delta(66)Zn(Imperial) ranging between -0.96 and -0.37 per thousand in coarse and between -1.04 and 0.02 per thousand in fine particular matter. This variability suggests that Zn isotopic compositions distinguish atmospheric sources. The isotopic light signature suggests traffic as the main source. We present further delta(66)Zn(Imperial) data for the standard reference material NIST SRM 2783 (delta(66)Zn(Imperial) = 0.26 +/- 0.10 per thousand).

Investigations into the kinetics and thermodynamics of Sb(III) adsorption on goethite (alpha-FeOOH).

This study reports thermodynamic and kinetic data of Sb(III) adsorption from single metal solutions onto synthetic aqueous goethite (alpha-FeOOH). Batch equilibrium sorption experiments were carried out at 25 degrees C over a Sb:Fe molar range of 0.005-0.05 and using a goethite concentration of 0.44 g Fe/L. Experimental data were successfully modelled using Langmuir (R2 > or = 0.891) and Freundlich (R2 > or = 0.990) isotherms and the following parameters were derived from triplicate experiments: Kf = 1.903 +/- 0.030 mg/g and 1/n = 0.728 +/- 0.019 for the Freundlich model and b = 0.021 +/- 0.003 L/mg and Qmax = 61 +/- 8 mg/g for the Langmuir model. The thermodynamic parameters determined were the equilibrium constant, Keq =1.323 +/- 0.045, and the Gibb's free energy, DeltaG0 = -0.692 +/- 0.083 kJ/mol. The sorption process is very fast. At a Sb:Fe molar ratio of 0.05, 40-50% of the added Sb is adsorbed within 15 min and a steady state is achieved. The experimental data also suggest that desorption can occur within 24 h of reaction due to the oxidation of Sb(III) on the goethite surface. Finally, calculated pH of the aqueous solution using MINTEQ2 agrees well with the measured pH (3.9 +/- 0.7; n = 30). At pH 4, the dominant Sb species in solution are Sb(OH)3 and HSbO2 which both likely adsorb as inner sphere complexes to the positively charged goethite surface.