Search

Soft tissue infections when not identified and treated on time, leads to severe morbidity and mortality. Various factors are mentioned in literature to predict the severity of the infection. They are not universal and is based on retrospective studies. Hence, we proposed this prospective study to assess the various parameters that predicts the severity in patients with soft tissue infections of the lower limb. A nested case control study was designed with a sample size of fifty-five in each arm. Patients were recruited on accrual basis and based on the outcome they were grouped under one of the two arms: non mortality, non-morbidity arm and mortality, morbidity arm. From the data collected, univariate and multivariate analysis were done to find significant variables predicting morbidity and mortality. The significant variables that predict morbidity in patients with soft tissue infections are Neutrophilia (p-0.079) (OR 1.06, CI 0.99 – 1.14), Hyponatremia (p-0.008) (OR 0.84, CI 0.74 – 0.96) and Fever (p-0.029) (OR 4.30, CI 1.16 – 15.92) at presentation. In patients, who presents to hospital with soft tissue infections of the lower limb, those showing significant neutrophilia (OR 1.06, CI 0.99 – 1.14), hyponatremia (OR 0.84, CI 0.74 – 0.96) and fever at presentation (OR 4.30, CI 1.16 – 15.92) have an increased likelihood of morbidity and mortality. Highlights: Soft tissue infections have high morbidity if not identified and treated early. Objective variables can help us in early diagnosis and prognostication of the patients with soft tissue infections. [ABSTRACT FROM AUTHOR]

Background and Aims Throughout the Cenozoic, Africa underwent several climatic and geological changes impacting the evolution of tropical rain forests (TRFs). African TRFs are thought to have extended from east to west in a 'pan-African' TRF, followed by several events of fragmentation during drier climate periods. During the Miocene, climate cooling and mountain uplift led to the aridification of tropical Africa and open habitats expanded at the expense of TRFs, which probably experienced local extinctions. However, in plants, these drivers were previously inferred using limited taxonomic and molecular data. Here, we tested the impact of climate and geological changes on diversification within the diverse clade Monodoreae (Annonaceae) composed of 90 tree species restricted to African TRFs. Methods We reconstructed a near-complete phylogenetic tree, based on 32 nuclear genes, and dated using relaxed clocks and fossil calibrations in a Bayesian framework. We inferred the biogeographical history and the diversification dynamics of the clade using multiple birth–death models. Key Results Monodoreae originated in East African TRFs ~25 million years ago (Ma) and expanded toward Central Africa during the Miocene. We inferred range contractions during the middle Miocene and document important connections between East and West African TRFs after 15–13 Ma. Our results indicated a sudden extinction event during the late Miocene, followed by an increase in speciation rates. Birth–death models suggested that African elevation change (orogeny) is positively linked to speciation in this clade. Conclusion East Africa is inferred as an important source of Monodoreae species, and possibly for African plant diversity in general. Our results support a 'sequential scenario of diversification' in which increased aridification triggered extinction of TRF species in Monodoreae. This was quickly followed by fragmentation of rain forests, subsequently enhancing lagged speciation resulting from vicariance and improved climate conditions. In contrast to previous ideas, the uplift of East Africa is shown to have played a positive role in Monodoreae diversification. [ABSTRACT FROM AUTHOR]

Premise: A probe set was previously designed to target 384 nuclear loci in the Melastomataceae family; however, when trying to use it, we encountered several practical and conceptual problems, such as the presence of sequences in reverse complement, intronic regions with stop codons, and other issues. This raised concerns regarding the use of this probe set for sequence recovery in Melastomataceae. Methods: In order to correct these issues, we cleaned the Melastomataceae probe set, extended it with additional sequences, and compared its performance with the original version. Results: The final probe set targets 396 putative nuclear loci represented by 6009 template sequences. The probe set has been made available, along with details on the cleaning process, for reproducibility. We show that the new probe set performs better than the original version in terms of sequence recovery. Discussion: This updated, extended, and cleaned probe set will improve the availability of phylogenomic resources across the Melastomataceae family. It is fully compatible with sequence recovery and extraction pipelines. The cleaning process can also be applied to any plant‐targeting probe set that would need to be cleaned or updated if new genomic resources for the targeted taxa become available. [ABSTRACT FROM AUTHOR]

Copyright of PhytoKeys is the property of Pensoft Publishers and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and Objectives: Thyroglossal duct cyst (TDC) is a common congenital cyst with an incidence of about 7%. Thyroglossal duct cyst carcinoma (TDCC) is a rare sequel which arises from TDC and has an incidence of about 1%. As these are rare, they do not have well-defined management guidelines. The aim of this study was to analyse the clinical profile and pathological characteristics of patients with thyroglossal duct cyst carcinoma and to propose a protocol for their treatment and follow-up. Materials and Methods: A retrospective study was done from January 2000 to December 2019. All the clinical details, imaging characteristics, treatment and histopathology were analysed. Results: The mean age group in our study was 37.9 years with a female preponderance. The clinical features like rapid increase in size, fixity of the lump and lymph node metastasis were not very common. Seventy-five percent of our patients who underwent imaging had suspicious characteristics. Fifty-six percent of our patients had FNAC suggestive of TDCC. Fifty percent of our patients had concomitant thyroid carcinoma. None of our patients had distant metastasis at follow-up. Conclusions: TDCC is rare and a disease of young adulthood and usually has good prognosis. It may be a clinical surprise or a small lesion which can be detected with ultrasound and targeted FNAC. There is high rate of concomitant thyroid carcinoma and hence needs careful assessment. Sistrunk's procedure with total thyroidectomy either staged or simultaneously has good outcome and permits adjuvant treatment. [ABSTRACT FROM AUTHOR]

The assessment of the fatigue crack growth rate behavior of welded structural components made of ultra-high strength steels (UHHS) is very important to gain a comprehensive understanding of these materials under high-cycle fatigue loadings and to enhance their applications in the construction industry. The literature on the fatigue crack growth rates of welded ultra-high strength steel plates with nominal yield strengths higher than 690 MPa is very scarce and only very limited research has been done thus far to provide the Paris' Law fatigue material constants for welded UHSS components in terms of the base metal (BM), the weld metal (WM), and the heat-affected zone (HAZ) regions, which are essential for fatigue life prediction. Hence, the fatigue crack growth rates of butt-welded UHSS plates with three grades (S700, S960, and S1100) are experimentally investigated in this study using Paris' Law for these three different regions of the welded components. Gas metal arc welding (GMAW) and laser welding (LW) methods are adopted to analyze the influence of welding methods on each steel grade with respect to their static and fatigue strength, microstructural changes, and hardness. In the fatigue crack growth rate test, it was observed that the S700 base material shows the lowest fatigue crack propagation resistance amongst these three grades. In welded components, laser welding outperforms gas welding in terms of the fatigue crack growth resistance. Comparisons of fatigue crack growth behaviors are made among all three tested UHSSs as well as with those from the literature. [ABSTRACT FROM AUTHOR]

The interrelationships of the extant crocodylians Gavialis gangeticus and Tomistoma schlegelii have been historically disputed. Whereas molecular analyses indicate a sister taxon relationship between these two gavialoid species, morphological datasets typically place Gavialis as the outgroup to all other extant crocodylians. Recent morphological‐based phylogenetic analyses have begun to resolve this discrepancy, recovering Gavialis as the closest living relative of Tomistoma; however, several stratigraphically early fossil taxa are recovered as closer to Gavialis than Tomistoma, resulting in anomalously early divergence timings. As such, additional morphological data might be required to resolve these remaining discrepancies. 'Tomistoma' dowsoni is an extinct species of gavialoid from the Miocene of North Africa. Utilising CT scans of a near‐complete, referred skull, we reconstruct the neuroanatomy and neurosensory apparatus of 'Tomistoma' dowsoni. Based on qualitative and quantitative morphometric comparisons with other crocodyliforms, the neuroanatomy of 'Tomistoma' dowsoni is characterised by an intermediate morphology between the two extant gavialoids, more closely resembling Gavialis. This mirrors the results of recent studies based on the external anatomy of these three species and other fossil gavialoids. Several neuroanatomical features of these species appear to reflect ecological and/or phylogenetic signals. For example, the 'simple' morphology of their neurosensory apparatus is broadly similar to that of other long and narrow‐snouted (longirostrine), aquatic crocodyliforms. A dorsoventrally short, anteroposteriorly long endosseous labyrinth is also associated with longirostry. These features indicate that snout and skull morphology, which are themselves partly constrained by ecology, exert an influence on neuroanatomical morphology, as has also been recognised in birds and turtles. Conversely, the presence of a pterygoid bulla in Gavialis and several extinct gavialoids, and its absence in Tomistoma schlegelii, could be interpreted as a phylogenetic signal of crocodylians more closely related to Gavialis than to Tomistoma. Evaluation of additional fossil gavialoids will be needed to further test whether these and other neuroanatomical features primarily reflect a phylogenetic or ecological signal. By incorporating such previously inaccessible information of extinct and extant gavialoids into phylogenetic and macroecological studies, we can potentially further constrain the clade's interrelationships, as well as evaluate the timing and ecological association of the evolution of these neuroanatomical features. Finally, our study supports recent phylogenetic analyses that place 'Tomistoma' dowsoni as being phylogenetically closer to Gavialis gangeticus than to Tomistoma schlegelii, indicating the necessity of a taxonomic revision of this fossil species. [ABSTRACT FROM AUTHOR]

Copyright of PhytoKeys is the property of Pensoft Publishers and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Wildfires have increased in frequency in many ecosystems, with implications for human health and the environment, including water quality. Increased fire frequency and urbanization also raise the prospect of fires burning into urban areas, mobilizing pollutants few have considered to date. As a result, water quality managers lack information to anticipate, respond to and potentially mitigate wildfire impacts. Here, we reviewed the scientific literature to assess wildfire effects on response endpoints of a conceptual model linking fire to water quality, quantifying response directionality, magnitude and duration. Physically, water yield, sediments, and temperature all increased post‐fire. Chemically, nutrients, ions, organic chemicals, and metals increased in burned watersheds, sometimes by orders of magnitude over pre‐fire or reference conditions. In select cases, post‐fire concentrations exceeded aquatic life criteria or drinking water standards, at times even in the finished drinking water. Biological assemblages commonly declined after post‐fire runoff events. The duration of effects was less than 5 yr for most endpoints (e.g., metals) on average following fire, although effects did extend 15 yr or more in some individual cases. We found only a few studies on pollutants mobilized from wildfire impacted urban areas with benzene contamination in drinking water and high metal concentrations in ash prominent exceptions. Overall, this review provides a resource for understanding wildfire impacts on water quality endpoints, with the goal of informing the response of managers and other decision makers to this growing problem. Plain Language Summary: Wildfires are increasing in frequency due in part to climate change, and the pollutants mobilized during and after fire threaten water quality. Water quality managers should be aware of these threats so they can plan for and respond to them. We reviewed the scientific literature on wildfire effects on water quality. Streamflow typically increases following wildfire, as do sediments and temperature. Nutrients, ions, metals, and certain organic chemicals often increase as well, sometimes 10–100 times or more above reference levels. Some post‐fire chemicals can exceed regulatory limits, even in finished drinking water (e.g., arsenic). Wildfire also commonly affects biological assemblages. Most impacts last less than 5 yr, although they can be much longer. Unfortunately, only a few studies measured pollutants from urban areas impacted by wildfire. This is a major knowledge gap since these events are likely becoming more common, can mobilize pollutants from built materials and may impact many water uses. Finally, our paper describes the implications for water quality programs, such as drinking water, water quality standards, assessment, restoration and non‐point source programs. We hope water quality managers and communities can use this information to better respond to this growing problem. Key Points: Post‐fire increases in many water quality pollutants exceeded pre‐fire levels, often by multiple orders of magnitudeNitrate, some metals, benzene, and disinfection by‐products exceeded regulatory levels in treated drinking water following some wildfiresLittle is known about pollutants from fires burning infrastructure and materials (e.g., houses, cars) within the wildland urban interface [ABSTRACT FROM AUTHOR]

Estimating time-dependent rates of speciation and extinction from dated phylogenetic trees of extant species (timetrees), and determining how and why they vary, is key to understanding how ecological and evolutionary processes shape biodiversity. Due to an increasing availability of phylogenetic trees, a growing number of process-based methods relying on the birth–death model have been developed in the last decade to address a variety of questions in macroevolution. However, this methodological progress has regularly been criticized such that one may wonder how reliable the estimations of speciation and extinction rates are. In particular, using lineages-through-time (LTT) plots, a recent study has shown that there are an infinite number of equally likely diversification scenarios that can generate any timetree. This has led to questioning whether or not diversification rates should be estimated at all. Here, we summarize, clarify, and highlight technical considerations on recent findings regarding the capacity of models to disentangle diversification histories. Using simulations, we illustrate the characteristics of newly proposed "pulled rates" and their utility. We recognize that the recent findings are a step forward in understanding the behavior of macroevolutionary modeling, but they in no way suggest we should abandon diversification modeling altogether. On the contrary, the study of macroevolution using phylogenetic trees has never been more exciting and promising than today. We still face important limitations in regard to data availability and methods, but by acknowledging them we can better target our joint efforts as a scientific community. [Birth–death models; extinction; phylogenetics; speciation.] [ABSTRACT FROM AUTHOR]

Background: The Ebo Forest area is a highly threatened centre of diversity in the Littoral Region of Cameroon, globally important for conservation with many threatened species including 68 threatened species of plant, yet not formally protected. The tropical African evergreen forest tree genus Uvariopsis Engl. & Diels (Annonaceae) is characterised by unisexual, usually cauliflorous flowers with a uniseriate corolla of four petals, and two sepals. Cameroon is the centre of diversity of the genus with 14 of the 19 known species. Methods: The herbarium collection MacKinnon 51 from Ebo is hypothesized to represent a new species to science of Uvariopsis. This hypothesis is tested by the study of herbarium specimens from a number of herbaria known to hold important collections from Cameroon and surrounding countries. Results: We test the hypothesis that MacKinnon 51 represents a new species to science, using the most recent dichotomous identification key, and comparing it morphologically with reference material of all known species of the genus. We make a detailed comparative morphological study focussing on three other Cameroonian species, Uvariopsis solheidii, U. korupensis and the sympatric U. submontana. In the context of a review of the pollination biology of Uvariopsis, we speculate that in a genus otherwise with species with dull, flesh-coloured (pink, red to brown) flowers pollinated (where known) by diptera, orthoptera and blattodea (flies, crickets and cockroaches), the glossy, pale yellow-green flowers of Uvariopsis dicaprio, with additional traits unique in the genus, may be pollinated by nocturnal moths. Based on MacKinnon 51, we formally name Uvariopsis dicaprio Cheek & Gosline (Annonaceae) as new to science, and we describe, and illustrate, and map it. Restricted so far to a single site in evergreen forest in the Ebo Forest, Littoral Region, Cameroon, Uvariopsis dicaprio is provisionally assessed as Critically Endangered using the IUCN, 2012 standard because the forest habitat of this species remains unprotected, and there exist imminent threats of logging and conversion to plantations. Discussion: We show that the highest density of species of the genus (12), and of narrow endemics (5), is found in the Cross-Sanaga Interval of SE Nigeria and Western Cameroon. A revised key to the 14 Cameroonian species of Uvariopsis is presented. We review the other seven narrowly endemic and threatened species unique to the Ebo forest of Cameroon and discuss the phytogeographic affinities of the area. Conclusions: Uvariopsis dicaprio adds to the growing list of species threatened with extinction at Ebo Forest due to current anthropogenic pressures. [ABSTRACT FROM AUTHOR]

This article describes a method for the active control of the deformations on a magnetically levitated moving-magnet planar motor. The planar motor under consideration is comprised of a stator on a double coil array configuration and a mover with permanent magnets, and it is designed to perform positioning tasks with nanometer level of accuracy. Due to the spatially asymmetric, nonuniform force distribution on the magnet plate, mechanical deformations are induced to the mover, which can severely hinder the desired positioning accuracy. The proposed method overcomes this challenge by properly shaping the force distribution on the moving magnet plate, which is enabled by the presence of multiple coils interacting with the mover, corresponding to an “overactuation” scheme. As a consequence, the independent control of elementary deformation shapes (modes) is achieved. The proposed overactuation scheme is experimentally validated on a planar motor prototype, proving the efficiency of the proposed method during both standstill and motion. [ABSTRACT FROM AUTHOR]

East Africa is a hotspot of biodiversity with many endemic plant species. We describe three new species of the genus Uvariodendron (Annonaceae) from the coastal forests of Kenya and Tanzania. Uvariodendron mbagoi Dagallier & Couvreur, sp. nov. is endemic to Tanzania and unique within the genus by its strong bergamot scent and its tomentose fruits having regular tufts of higher hair density. Uvariodendron dzomboense Dagallier, W.R.Q. Luke & Couvreur, sp. nov. is endemic to Dzombo Hill in Kenya and is rendered distinct by its small leaves and very densely pubescent carpels. Uvariodendron schmidtii W.R.Q. Luke, Dagallier & Couvreur, sp. nov. is endemic to Shimba Hills in Kenya and differs by its small flowers and fused sepals forming a ring. Following IUCN criteria we assessed U. mbagoi and U. dzomboense as endangered (EN) while U. schmidtii is assessed as Vulnerable (VU). We also propose a new combination: Polyceratocarpus oligocarpus (Verdc.) Dagallier, comb. nov. The description of these three new species underlines the richness in endemics in East Africa and that new discoveries might arise from further botanical exploration of this region. [ABSTRACT FROM AUTHOR]

Background: We aim to analyze the clinicopathological profile and outcomes of management for children with papillary thyroid carcinoma (PTC). Methods: Relevant clinical data of children ≤ 18 years of age managed for PTC between January 2006 and July 2018 as well as details of their follow-up till December 2019 were retrospectively collected and analyzed. Results: There were 82 children with PTC that were managed during the study period. At presentation, 39 (47.6%) had cervical lymphadenopathy, while 9 (11%) had systemic metastasis. Majority of patients 39 (47.6%) underwent total thyroidectomy with a selective neck dissection, while total thyroidectomy alone was performed in 26 (31.7%). Following surgery, hypocalcemia was seen in 39 (47.6%): 28 (34.1%) were temporary, while 11 (13.4%) were permanent. Twenty-eight (34%) developed persistent disease after surgery and 131I therapy. Significant risk factors for persistence and metastatic disease were metastatic cervical lymph node at presentation (p = 0.002) and tumor size (p = 0.014), respectively. The mean duration of follow-up was 60.3 (range 12–150) months with a mean overall disease-free survival of 60 months (95% CI 57.11, 77.95). Conclusion: Children with papillary thyroid cancers present with aggressive disease, 47.6% with cervical nodal metastasis and 11% with distant metastasis in this cohort. The rate of post-thyroidectomy hypocalcemia in this study is substantial, and efforts to reduce it are actively being pursued. The presence of metastatic cervical lymph node at presentation (p = 0.002) and tumor size (p = 0.014) were the only significant risk factors for persistent and metastatic disease, respectively, in this study. [ABSTRACT FROM AUTHOR]

Spontaneous adrenal hemorrhage is a rare clinical entity which can lead to an adrenal crisis, shock, and death. We conducted this study to analyze the etiopathogenesis, clinical presentation, imaging modality, and treatment of patients with spontaneous adrenal hemorrhage. Retrospective analysis of 18 patients with spontaneous adrenal hemorrhage managed between 2005 and 2017 at a single institution was performed. The most common presenting symptom was abdominal pain in 10 (55.6%) patients. Contrast-enhanced computerized tomography (CECT) was the most commonly used diagnostic modality (16/18 [88%]). Bilateral adrenal hemorrhage was seen in 6 patients (33%). Adrenal insufficiency was detected in 7 (38.9%) and these patients received steroid therapy. Etiology of the bleed included idiopathic (5 [27.8%]), antiphospholipid antibody syndrome (APLA) (5 [27.8%]), and pheochromocytoma (4 [22.2%]), associated with pregnancy, anticoagulant use, pseudoaneurysm, and myelolipoma in 1 (5.5%) each. Nine (50%) patients could be managed conservatively, and 8 (44.4%) required adrenalectomy while embolization was performed in one (5.6%). There were no mortalities. In this series, the most common clinical presentation of a patient with spontaneous adrenal hemorrhage was abdominal pain. The detection of an unexplained adrenal hemorrhage should prompt one to look for predisposing conditions like APLA. Patients with adrenal hemorrhage should be evaluated for adrenal insufficiency and if present, steroid therapy needs to be initiated. As seen in this series, not all patients with adrenal hemorrhage require an adrenalectomy. [ABSTRACT FROM AUTHOR]

Summary: Determining where species diversify (cradles) and persist (museums) over evolutionary time is fundamental to understanding the distribution of biodiversity and for conservation prioritization. Here, we identify cradles and museums of angiosperm generic diversity across tropical Africa, one of the most biodiverse regions on Earth.Regions containing nonrandom concentrations of young (neo‐) and old (paleo‐) endemic taxa were identified using distribution data of 1719 genera combined with a newly generated time‐calibrated mega‐phylogenetic tree. We then compared the identified regions with the current network of African protected areas (PAs).At the generic level, phylogenetic diversity and endemism are mainly concentrated in the biogeographically complex region of Eastern Africa. We show that mountainous areas are centres of both neo‐ and paleo‐endemism. By contrast, the Guineo‐Congolian lowland rain forest region is characterized by widespread and old lineages. We found that the overlap between centres of phylogenetic endemism and PAs is high (> 85%).We show the vital role played by mountains acting simultaneously as cradles and museums of tropical African plant biodiversity. By contrast, lowland rainforests act mainly as museums for generic diversity. Our study shows that incorporating large‐scale taxonomically verified distribution datasets and mega‐phylogenies lead to an improved understanding of tropical plant biodiversity evolution. [ABSTRACT FROM AUTHOR]

Phylogenies are a central and indispensable tool for evolutionary and ecological research. Even though most angiosperm families are well investigated from a phylogenetic point of view, there are far less possibilities to carry out large-scale meta-analyses at order level or higher. Here, we reconstructed a large-scale dated phylogeny including nearly 1/8th of all angiosperm species, based on two plastid barcoding genes, matK (incl. trnK) and rbcL. Novel sequences were generated for several species, while the rest of the data were mined from GenBank. The resulting tree was dated using 56 angiosperm fossils as calibration points. The resulting megaphylogeny is one of the largest dated phylogenetic tree of angiosperms yet, consisting of 36,101 sampled species, representing 8,399 genera, 426 families and all orders. This novel framework will be useful for investigating different broad scale research questions in ecological and evolutionary biology. [ABSTRACT FROM AUTHOR]

We conducted this audit to assess and improve the quality of care for patients undergoing thyroid surgery at our institution. The audit process began in 2012. Key performance indicators assessed were rates of hypocalcemia (immediate postoperative, temporary and permanent), recurrent laryngeal nerve (RLN) injury, chyle leak rate, re-exploration for chyle leak and post-thyroidectomy haemorrhage. Data of patients undergoing thyroidectomy from 1st January to 31st December 2011 was retrospectively collected from the electronic database. Performance indicators were assessed and compared to international standards. Actions to correct the short falls were implemented and retrospective re-audits were performed on prospectively collected data in subsequent years until 2015. The data was analysed using STATA IC/13.1. There has been a steady increase in the number of thyroidectomies performed/year from 357 in 2011 to 577 in 2015. The most common procedure performed was total thyroidectomy (~70%) and histopathology revealed thyroid malignancy in the majority of patients. Over 5 years, a significant improvement in the rates of post-thyroidectomy immediate and temporary hypocalcemia was witnessed (p < 0.001) as well as a near significant fall in permanent hypocalcemia and RLN injury rate (p = 0.06). In 2014 and 2015, no patients were re-explored for a chyle leak. The rate of post-thyroidectomy haemorrhage (1.2–1.8%) has remained static over 5 years. This audit portrays specialisation in endocrine surgery and high volumes of patients treated have resulted in a significant improvement in outcomes for patients following thyroid surgery that meet international standards. [ABSTRACT FROM AUTHOR]

Summary: Lithium‐ion batteries are indispensable in various applications owing to their high specific energy and long service life. Lithium‐ion battery models are used for investigating the behavior of the battery and enabling power control in applications. The Doyle‐Fuller‐Newman (DFN) model is a popular electrochemistry‐based model, which characterizes the dynamics in the battery through diffusions in solid and electrolyte and predicts current/voltage response. However, the DFN model contains a large number of parameters that need to be estimated to obtain an accurate battery model. In this paper, a computationally feasible two‐step estimation approach is proposed that only uses voltage and current measurements of the battery under consideration. In the two‐step procedure, the parameters are divided into 2 groups. The first group contains thermodynamic parameters, which are estimated using low‐current discharges, while the second group contains kinetic parameters, which are estimated using a well‐designed highly‐dynamic pulse (dis‐)charge current. A parameter sensitivity analysis is done to find a subset of parameters that can be reliably estimated using current and voltage measurements only. Experimental data are collected for 12 Ah nickel cobalt aluminum pouch lithium‐ion cell. The voltage predictions of the identified model are compared with several experimental data sets to validate the model. A root mean square error between model predictions and experimental data smaller than 16 mV is achieved. [ABSTRACT FROM AUTHOR]

We conducted this study to evaluate the demography, clinical presentation, management and outcomes of medullary thyroid carcinoma (MTC) from the Indian context. This was a retrospective study of patients with MTC managed between January 2008 and December 2016. All pertinent data was collected and the results were analysed using STATA (v.13.1). MTC accounted for 90/2022 (4.45%) patients managed with thyroid cancer during the study period. The mean age of presentation was 40 years (range 14-70 years) with 47 males and 43 females. The most common presentation included goitre with cervical lymphadenopathy seen in 60 patients (66.7%). There were 11 patients (12.2%) with systemic metastasis at presentation. Rearranged during transfection (RET) testing was performed in 71 patients and was positive in 25 (35.2%). The mutations among these patients were seen in the following codons: 634 (12), 804 (8), 790 (3) and 618 (2). Persistent hypercalcitoninemia (calcitonin > 50 pg/ml) was observed in 62/80 (77.5%) patients. Forty patients underwent a meta-iodo-benzyl-guanidine (MIBG) scan in the postoperative period, 10 were positive. The mean duration of follow-up was 32 months and 10 patients defaulted from follow-up. Sixteen patients developed metastasis during the period of follow-up while eight patients expired. The mean survival was 85.75 months (95% CI 78.7-92.7). MTC accounted for 4.5% of thyroid carcinomas in this cohort among which 35% were hereditary. Persistent hypercalcitoninemia following surgery is seen in more than 70% of patients but this does not affect survival. RET screening should be performed for all patients with MTC as curative surgery can be offered for mutation positive offspring. [ABSTRACT FROM AUTHOR]

Estimation of physical parameters in dynamical systems driven by linear partial differential equations is an important problem. In this paper, we introduce the least costly experiment design framework for these systems. It enables parameter estimation with an accuracy that is specified by the experimenter prior to the identification experiment, while at the same time minimising the cost of the experiment. We show how to adapt the classical framework for these systems and take into account scaling and stability issues. We also introduce a progressive subdivision algorithm that further generalises the experiment design framework in the sense that it returns the lowest cost by finding the optimal input signal, and optimal sensor and actuator locations. Our methodology is then applied to a relevant problem in heat transfer studies: estimation of conductivity and diffusivity parameters in front-face experiments. We find good correspondence between numerical and theoretical results. [ABSTRACT FROM AUTHOR]

Frozen section analysis ( FS) during cancer surgery is widely used to assess resection margins. However, in hilar cholangiocarcinoma ( HCCA), FS may be less reliable because of the specific growth characteristics of the tumor. The aim of this study was to determine the accuracy and consequences of intraoperative FS of the proximal bile duct margins in HCCA. Between 1990 and 2014, 67 patients underwent combined extrahepatic bile duct resection and partial liver resection for HCCA with the use of FS. Sensitivity and specificity of FS was 68% and 97%, respectively. Seventeen of 67 patients (25%) displayed a positive bile duct margin at FS. The false-negative rate was 16% (eight patients). Ten patients (15%) with a positive bile duct margin underwent an additional resection in an attempt to achieve negative margins, which succeeded in three patients (4%). However, only one of these three patients did not have concomitant lymph node metastases, which are associated with a poor prognosis by itself. The use of FS of the proximal bile duct is of limited clinical value because of the relatively low sensitivity, high risk of false-negative results, and the low rate of secondary obtained tumor-free resection margins. Supported by the literature, a new approach to the use of FS in HCCA should be adopted, reserving the technique only for cases in which a substantial additional resection is possible. [ABSTRACT FROM AUTHOR]

Background: Choledochal malformation (CM) is a rare medical condition of which 80% are diagnosed in pediatric patients. There are several important controversies regarding diagnostic workup, management, and follow-up in these pediatric patients. To assess preferences and practices of Dutch pediatric surgeons regarding the diagnostic procedures, management, and follow-up of children with CM we conducted an electronic survey.Methods: A questionnaire was sent to all the pediatric surgeons working in the academic centers and the only community hospital with a pediatric surgery service. The questionnaire included, items regarding incidence, diagnostic workup, interval between diagnosis and surgery, surgical techniques, and follow-up. We also assessed whether personal exposure influenced the preferences and practices.Results: Overall 22 out of the 31 (71%) Dutch pediatric surgeons returned the questionnaire. Total 15 out of 22 (68%) encountered CM up to 2 times/y, whereas 7 out of 22 (32%) encountered it more than 2 times/y. Indications for surgery were significantly different between surgeons who encountered CM > 2 time/y versus those who did not: 6/6 (100%) of surgeons encountering CM > 2 times/y considered the presence of an asymptomatic CM an indication for surgery versus 5/14 (36%) of the pediatric surgeons who encountered a CM up to 2 times/y (p = 0.01). Overall 12 out of the 22 (55%) respondents preferred surgery between 6 months and 2 years of age. The amount of exposure did not differ in preferred age at surgery or surgical technique. In the symptomatic child 10/22 (45%) of respondents preferred surgery within 3 months. Overall 7/22 (32%) favored laparoscopic resection. Hepaticojejunostomy with Roux-en-Y reconstruction was the preferred reconstruction for all the respondents. One-third stated that they never performed a parenchyma resection. Follow-up was limited to 10 years in almost half of the respondents.Conclusion: Dutch pediatric surgeons demonstrate a wide variety of opinions regarding diagnostic workup, treatment, and follow-up of CM. While most surgeons encounter CM up to 2 times/y, there is an association between exposure and several of the outcome parameters. Some of the answers are not in line with the expert opinion. This demonstrates that there is a need for evidence-based (inter)national guidelines regarding the diagnostic approach, management, and follow-up. [ABSTRACT FROM AUTHOR]

Little is known about the achievement of developmental milestones (i.e., COL) after pediatric liver transplantation. The aim of this study was to examine the COL of young adults who underwent a liver transplantation during childhood and to compare it to healthy peers. Furthermore, we studied factors possibly related to their COL. COL was assessed using the CLQ, which assesses the achievement of developmental milestones (autonomy, psychosexual, social, and antisocial development) and risk behavior (substance abuse and gambling). Sociodemographic characteristics and clinical data were collected using the prospective institutional liver transplantation database. A total of 39 young adults who underwent a liver transplantation at the UMCG in their childhood completed the CLQ. They achieved fewer milestones with regard to autonomy, psychosexual, and social development compared to healthy peers, and they reported less risk behavior. Neither age at the time of study nor age at the time of transplantation was significantly correlated with any of the COL subscales. Young adults show delay in reaching developmental milestones in every dimension after a liver transplantation during their childhood. [ABSTRACT FROM AUTHOR]

If any engineering courses are unlikely to be transferable between Australasian and overseas universities, one could argue that civil engineering capstone design courses with a strong practical engineering focus would be the least likely. This analysis considers two capstone design courses in the US and New Zealand. The analysis examines the approaches each university has taken to improve design education through simulating professional practice. The two approaches are superficially very different with different course structure and course requirements. In addition the emphasis on site and project, and the consequent dependence on country-specific matters related to regulation and codes, would lead one to expect low transferability. Closer analysis shows that the learning objectives of the courses are relatively similar and that the relationship between site and design are key for both. The challenges faced by the two approaches have much in common, reflecting similar student experiences, and so high transferability. The paper provides details on learning objectives and challenges faced at the two programs to aid others who wish to analyse capstone design experiences across multiple universities. The conclusion is that transferability between these two design experiences is high. The implication is that, through similar forces for educational change in both countries, internationalisation of engineering education is high. [ABSTRACT FROM AUTHOR]

Introduction Gaining an insight into the quality of life (QOL) in long-term biliary atresia (BA) survivors is becoming more important. Identifying patients with limitations might make tailor made interventions possible. This is the first study investigating the health status (HS) and QOL in adults surviving BA with their native livers, and comparing them with healthy peers. Methods BA patients surviving with their native liver were identified in the Netherlands Study Group on Biliary Atresia Registry database. The RAND-36 and the World Health Organization Quality of Life assessment instrument-100 (WHOQOL-100) were used to measure HS and QOL, respectively. Correlation between the RAND-36 and WHOQOL-100 was also assessed. Hospital Anxiety and Depression Scale (HADS) and the Impact Event Scale (IES) were also completed. Results In total, 25 (83%) of the 30 eligible patients after Kasai portoenterostomy completed the questionnaires (median age 23.2 years). A lower perceived level of general health in HS was found as compared with the reference group and a higher score on the social domain was reported in QOL. Correlations between HS and QOL questionnaires were moderate to good. For the group, overall HADS and IES scores were good, though individual patients did score above the cutoff of both the questionnaires. Conclusion Adult BA patients surviving with their native liver have similar HS and QOL as compared with their healthy peers. RAND-36 and WHOQOL-100 questionnaires are not interchangeable, but complementary to assess the patients' outcomes. The overall scores did not point to increased levels of anxiety and depression. However, on an individual level, three and six patients had a score above the cutoff of the HADS subscales demonstrating clinically relevant levels of anxiety and depression, respectively. [ABSTRACT FROM AUTHOR]

Determining the mutational status of susceptibility genes including RET, VHL, SDHx (SDHB, SDHC, SDHD) among patients with pheochromocytoma/paraganglioma (PCC/PGL) is gaining importance. These genes have not been systematically characterized among patients with PCC/PGL from India. The aim of the work was to screen the most frequently mutated genes among patients with PCC/PGL to determine the frequency and spectrum of mutations seen in this region. Fifty patients with PCC/PGL treated at our tertiary care hospital between January 2010 and June 2012 were screened for mutations in susceptibility genes using an algorithmic approach. Thirty two percent (16/50) of patients were found to be positive for mutations including mutations among RET (n = 4), VHL (n = 6), SDHB (n = 3), and SDHD (n = 3) genes. None of these patients were positive for SDHC mutations. A significant association was found between young patients with bilateral tumors and VHL mutations (p = 0.002). Two of the 3 patients with extra-adrenal SDHB associated tumors, had unique mutations, viz., c.436delT (exon 5) and c.788_857del (exon 8), one of which was malignant. High frequency of mutations seen among patients in this study emphasizes the need to consider mutational analysis among Indian patients with PCC/PGL. [ABSTRACT FROM AUTHOR]

Background Effective chemotherapy rapidly reduces the spin--lattice relaxation of water protons (T1) in solid tumours and this change (ΔT1) often precedes and strongly correlates with the eventual change in tumour volume (TVol). To understand the biological nature of ΔT1, we have performed studies in vivo and ex vivo with the allosteric mTOR inhibitor, everolimus. Mice bearing RIF-1 tumours were studied by magnetic resonance imaging (MRI) to determine TVol and T1, and MR spectroscopy (MRS) to determine levels of the proliferation marker choline and levels of lipid apoptosis markers, prior to and 5 days (endpoint) after daily treatment with vehicle or everolimus (10 mg/kg). At the endpoint, tumours were ablated and an entire section analysed for cellular and necrotic quantification and staining for the proliferation antigen Ki67 and cleaved-caspase-3 as a measure of apoptosis. The number of blood-vessels (BV) was evaluated by CD31 staining. Mice bearing B16/BL6 melanoma tumours were studied by MRI to determine T1 under similar everolimus treatment. At the endpoint, cell bioluminescence of the tumours was measured ex vivo. Results Everolimus blocked RIF-1 tumour growth and significantly reduced tumour T1 and total choline (Cho) levels, and increased polyunsaturated fatty-acids which are markers of apoptosis. Immunohistochemistry showed that everolimus reduced the%Ki67+ cells but did not affect caspase-3 apoptosis, necrosis, BV-number or cell density. The change in T1 (ΔT1) correlated strongly with the changes in TVol and Cho and%Ki67+. In B16/BL6 tumours, everolimus also decreased T 1 and this correlated with cell bioluminescence; another marker of cell viability. Receiver-operating-characteristic curves (ROC) for everolimus on RIF-1 tumours showed that ΔT1 had very high levels of sensitivity and specificity (ROCAUC = 0.84) and this was confirmed for the cytotoxic patupilone in the same tumour model (ROCAUC = 0.97). Conclusion These studies suggest that ΔT1 is not a measure of cell density but reflects the decreased number of remaining viable and proliferating tumour cells due to perhaps cell and tissue destruction releasing proteins and/or metals that cause T1 relaxation. ΔT1 is a highly sensitive and specific predictor of response. This MRI method provides the opportunity to stratify a patient population during tumour therapy in the clinic. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Phyllodes tumors (PT) of the breast seem to get pre-operatively misdiagnosed as fibroadenomas resulting in inadequate resections and high local recurrence rates. MATERIALS AND METHODS: Data of 150 patients with PT of the breast managed from January, 2003 to February, 2013 were retrospectively analyzed. Statistical analysis performed using SPSS version 17 (Pearson Chi-square test and analysis of variance test for analysis). AIM: The aim of this study is to compare clinico-pathological profile and recurrence rates in patients with benign (B), borderline malignant (BL) and malignant (M) PT. RESULTS: In a total of 150 patients with PT (n = 77 B, n = 24 BL, n = 49 M), mean age was 36.92, 44.04 and 40.46 years respectively (P 0.015) and mean tumor size being 8.15 cm, 14.7 cm and 12.9 cm respectively (P 0.000). Pre-operatively cytology suggestive of PT in 24% patients with B PT and 63% in M PT; core tissue biopsy suggestive of PT in 85.4% patients with B PT and 100% in M PT. Recurrence seen in 34.7% out of which 32.7% were post-lumpectomy performed elsewhere. Majority of B PT had lumpectomy (49.3%)/ wide local excision (WLE, 31.2%) compared with M PT where 55.1% had simple mastectomy (SM) due to large tumor size. Local recurrence was more in M PT (53%) compared with B PT (20%). We found recurrence rates in L (39.3%) compared with WLE (27.3%) and SM (33.9%) (P 0.049). CONCLUSIONS: Larger tumor size, incomplete resection and M/BL histology predicted higher recurrence in PT. Core biopsy is much more accurate than fine needle cytology in the diagnosis. [ABSTRACT FROM AUTHOR]

We investigate the response of multi-layer epitaxial graphene and chemical vapor deposition (CVD)-grown single-layer graphene to strong terahertz (THz) fields. Contrary to theoretical predictions of strong nonlinear response, the transmitted fields exhibit no harmonic generation, indicating that the nonlinear response is limited by fast electron thermalization due to carrier-carrier scattering. The fast electron heating gives rise to large THz transmission enhancement (>15%) in single-layer CVD graphene at high THz fields (ETHz > 10 kV cm-1). The nonlinear effects exhibit non-Drude behavior in the THz conductivity, where THz fields induce extreme non-equilibrium electron distributions. [ABSTRACT FROM AUTHOR]

We demonstrate time-resolved terahertz transmission ellipsometry of vertically aligned multi-walled carbon nanotubes. The angle-resolved transmission measurements reveal anisotropic characteristics of the terahertz electrodynamics in multi-walled carbon nanotubes. The anisotropy is, however, unexpectedly weak: the ratio of the tube-axis conductivity to the transverse conductivity, σz/σxy≅2.3, is nearly constant over the broad spectral range of 0.4-1.6 THz. The relatively weak anisotropy and the strong transverse electrical conduction indicate that THz fields readily induce electron transport between adjacent shells within multi-walled carbon nanotubes. [ABSTRACT FROM AUTHOR]

Commonly, controllers for linear parameter-varying (LPV) systems are designed in continuous time using a linear fractional representation (LFR) of the plant. However, the resulting controllers are implemented on digital hardware. Furthermore, discrete-time LPV synthesis approaches require a discrete-time model of the plant which is often derived from a continuous-time first-principle model. Existing discretization approaches for LFRs describing LPV systems suffer from disadvantages like the possibility of serious approximation errors, issues of complexity, etc. To explore the disadvantages, existing discretization methods are reviewed and novel approaches are derived to overcome them. The proposed and existing methods are compared and analyzed in terms of approximation error, considering ideal zero-order hold actuation and sampling. Criteria to choose appropriate sampling times with respect to the investigated methods are also presented. The proposed discretization methods are tested and compared both on a simulation example and on the electronic throttle control problem of a race motorcycle. [ABSTRACT FROM AUTHOR]

This paper presents an output feedback nonlinear model-based control approach for optimal operation of industrial batch crystallizers. A full population balance model is utilized as the cornerstone of the control approach. The modeling framework allows us to describe the dynamics of a wide range of industrial batch crystallizers. In addition, it facilitates the use of performance objectives expressed in terms of crystal size distribution. The core component of the control approach is an optimal control problem, which is solved by the direct multiple shooting strategy. To ensure the effectiveness of the optimal operating policies in the presence of model imperfections and process uncertainties, the model predictions are adapted on the basis of online measurements using a moving horizon state estimator. The nonlinear model-based control approach is applied to a semi-industrial crystallizer. The simulation results suggest that the feasibility of real-time control of the crystallizer is largely dependent on the discretization coarseness of the population balance model. The control performance can be greatly deteriorated due to inadequate discretization of the population balance equation. This results from structural model imperfection, which is effectively compensated for by using the online measurements to confer an integrating action to the dynamic optimizer. The real-time feasibility of the output feedback control approach is experimentally corroborated for fed-batch evaporative crystallization of ammonium sulphate. It is observed that the use of the control approach leads to a substantial increase, i.e., up to 15%, in the batch crystal content as the product quality is sustained. [ABSTRACT FROM AUTHOR]

Significant recent interest has focussed on improving outcomes after emergency laparotomy. This retrospective database analysis estimated the annual incidence and associated inpatient costs of emergency laparotomy in England. Demographic, process and outcome data were collected for all patients undergoing emergency laparotomy in Brighton for two calendar years (2009-2010). Cost analysis assumed £16 per minute theatre time, and £282 per day ward bed and £1382 per day critical care bed costs. National incidence was confirmed from Hospital Episode Statistics and Office of National Statistics mid-year population data. In total, 768 patients underwent 850 emergency laparotomies. The incidence of emergency laparotomy was estimated as ∼1:1100 population. Thirty-six percent (276 patients) were admitted for a median (IQR [range]) of 5 (3-11 [1-76]) days of critical care. Postoperative median (IQR [range]) length of stay was 13 (8-24 [1-176]) days. Our estimated annual inpatient cost of emergency laparotomy for Brighton was ∼£5 million, equivalent to ∼£13 000 per patient, and for England, an annual estimated cost of ∼£650 million. However, 'Payment by Results' reimbursement amounted to a mean (SD) hospital income of just £6905 (2639) per patient, a net financial loss of ∼£6100 per patient, equivalent to a reimbursement shortfall nationally of ∼£300 million. We also found that patients > 70 years (46%) had significantly higher 30-day postoperative mortality (18% vs 6%, p < 0.0001), significantly prolonged median (IQR [range]) length of stay (15 (10-26 [1-123]) days vs 12 (7-22 [1-176]) days, p < 0.001) and incurred higher costs (median (IQR [range]) £9667 (6620-15 732 [1920-103 624]) vs £7467 (4975-14 251 [1178-118 060]), p < 0.001). Emergency laparotomy is a common procedure associated with considerable cost, particularly among elderly patients. A National Emergency Laparotomy Database will help provide an evidence base on which to improve clinical outcome and cost efficiency. [ABSTRACT FROM AUTHOR]

Neuroibromatosis type 1 is the most common phakomatoses and is inherited in autosomal dominant fashion with complete penetrance. Secondary hypertension is common in these patients due to various causes including adrenal tumors. Pheochromocytoma is a rare catecholamine producing tumor seen in 0.5% to 5% of patients with neuroibromatosis. The combination of pheochromocytoma with neuroibromatosis is rarely reported in the literature. We recently encountered an elderly lady with this combination who successfully underwent adrenalectomy. We report the case for the uncommon occurrence and to highlight the relevant literature review about pheochromocytoma in neuroibromatosis. [ABSTRACT FROM AUTHOR]