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Appropriate and effective wound cleaning represents an important process that is necessary for preparing the wound for improved wound healing and for helping to dislodge biofilms. Wound cleaning is of paramount importance to wound bed preparation for helping to enhance wound healing. Surfactant applications in wound care may represent an important area in the cleaning continuum. However, understanding of the role and significance of surfactants in wound cleansing, biofilm prevention and control, and enhancing cellular viability and proliferation is currently lacking. Despite this, some recent evidence on poloxamer‐based surfactants where the surfactants are present in high concentration have been shown to have an important role to play in biofilm management; matrix metalloproteinase modulation; reducing inflammation; and enhancing cellular proliferation, behaviour, and viability. Consequently, this review aims to discuss the role, mode of action, and clinical significance of the use of medically accepted surfactants, with a focus on concentrated poloxamer‐based surfactants, to wound healing but, more specifically, the role they may play in biofilm management and effects on cellular repair.

On 9 May 2018, the authors took part in a closed panel discussion on the impact of cell salvage in acute and chronic wounds. The goal was to deliberate the possible use of plurogel micelle matrix (PMM) as a new treatment strategy for wound healing and the authors openly shared their experiences, thoughts, experimental data and early clinical results. The outcome of the panel discussion has been abridged in this paper. The cell membrane consists of a lipid bilayer, which provides a diffusion barrier separating the inside of a cell from its environment. Cell membrane injury can result in acute cellular necrosis when defects are too large and cannot be resealed. There is a potential hazard to the body when these dying cells release endogenous alarm signals referred to as ‘damage (or danger) associated molecular patterns' (DAMPs), which trigger the innate immune system and modulate inflammation. Cell salvage by membrane resealing is a promising target to ensure the survival of the individual cell and prevention of further tissue degeneration by inflammatory processes. Non-ionic surfactants such as poloxamers, poloxamines and PMM have the potential to resuscitate cells by inserting themselves into damaged membranes and stabilising the unstable portions of the lipid bilayers. The amphiphilic properties of these molecules are amenable to insertion into cell wall defects and so can play a crucial, reparative role. This new approach to cell rescue or salvage has gained increasing interest as several clinical conditions have been linked to cell membrane injury via oxidative stress-mediated lipid peroxidation or thermal disruption. The repair of the cell membrane is an important step in salvaging cells from necrosis to prevent further tissue degeneration by inflammatory processes. This is applicable to acute burns and chronic wounds such as diabetic foot ulcers (DFUs), chronic venous leg ulcers (VLUs), and pressure ulcers (PUs). Experimental data shows that PMM is biocompatible and able to insert itself into damaged membranes, salvaging their barrier function and aiding cell survival. Moreover, the six case studies presented in this paper reveal the potential of this treatment strategy.

Successfully treating shoulder arthroplasty infection requires diagnosis and bacterial identification. Higher incidence of infection with low-virulence bacteria makes this challenging. This study evaluates shoulder prostheses for infection using sonication and a functional biofilm assay. Nineteen patients undergoing revision shoulder arthroplasty were followed prospectively. Periprosthetic tissue and prosthetic components were obtained during the revision and evaluated with a functional biofilm assay. Results were compared with conventional cultures and laboratory results. Hardware samples were analyzed with scanning electron microscopy. Six of the 19 cases demonstrated growth on the biofilm assay. Three of these had positive conventional culture results and met Musculoskeletal Infection Society (MSIS) criteria for infection. Two other cases met MSIS criteria but demonstrated negative assay and conventional culture results. Of the six cases with positive assay results, three demonstrated evidence of biofilm on scanning electron microscopy. The biofilm assay identifies infections not recognized by traditional culture or MSIS criteria. (Journal of Surgical Orthopaedic Advances 27(3):171-177, 2018).

A biofilm is a community of microorganisms that adhere to each other and to surfaces and secrete extracellular polymeric substances (EPS) encasing themselves in a matrix. Biofilms are a major healthcare concern, as they can form on medical devices leading to infection. Additionally, there is growing evidence to show their ability to form in chronic wounds, which leads to delayed wound healing and inflammation. Due to a number of reasons, such as formation of the EPS resulting in sub-inhibitory concentrations of antimicrobials reaching the bacterial cells, slow growth rate of bacterial cells rendering some antibiotics ineffective, and the presence of persister cells, biofilms show increased tolerance to many antimicrobials and antibiotics. Additionally, studies have started to emerge showing a link between resistance to antimicrobials and antibiotics. Cross-resistance can be attributed to a number of factors, for example, increased expression of multidrug efflux pumps that efflux a wide range of substrates and horizontal gene transfer of genetic material encoding multiple resistance genes between different species within the polymicrobial biofilm. Antimicrobial resistance is an increasing threat caused by multiple factors including cross-resistance, and it is a global health concern. This review focuses on current research on antimicrobial and antibiotic resistance and cross-resistance found between antimicrobials and antibiotics commonly used in woundcare to evaluate the significance of this acquired antibiotic resistance. Furthermore, the review discusses the significance of antimicrobial tolerance and the role biofilms play in enhancing antibiotic resistance.

The objective of this study was to evaluate the safety and effectiveness of ultrasound-accelerated thrombolysis in acute pulmonary embolism.A retrospective study of 45 patients was performed to evaluate treatment of acute pulmonary embolism at a single center from January 2011 to December 2013. All patients were diagnosed with computed tomography or ventilation-perfusion scan and had hemodynamic instability (systolic blood pressure100 mm Hg) or right-sided heart strain evidenced by right ventricular dilation, septal deviation, or hypokinesis by echocardiography or computed tomography. EkoSonic catheters (EKOS Corporation, Bothell, Wash) were placed into the affected pulmonary arteries, and recombinant tissue plasminogen activator was infused through the catheters at 0.5 to 1.0 mg/h per catheter.Hypotension (systolic blood pressure100 mm Hg) was present in 12 patients, with 100% resolution by treatment completion. Tachycardia (heart rate100 beats/minute) was present in 26 patients and resolved in 92% by treatment completion; the average heart rate for all patients decreased from 109 to 77 beats/minute during the treatment period. Direct pulmonary artery pressure measurement showed average decrease of 21.5 mm Hg, representing a 40.2% reduction. Postprocedure echocardiography demonstrated complete resolution of cardiac dysfunction in 64%. Patients received a total dose of 30.5 mg (range, 14-66 mg) recombinant tissue plasminogen activator during an infusion time of 14.2 hours (range, 8-21 hours). There were no deaths through 90 days of follow-up and no major periprocedural bleeding events.This retrospective study demonstrates the safety and efficacy of current ultrasound-accelerated thrombolysis methods to treat acute pulmonary embolism.

Objectives To evaluate longer-term safety and efficacy of a single self-expanding stent up to 20 cm in length in patients with atherosclerotic disease of the superficial femoral (SFA) and proximal popliteal arteries. Background Angioplasty and stenting are options for revascularization of symptomatic peripheral artery disease. While angioplasty alone is effective in short lesions, outcomes in longer lesions (i.e., mean 8.7 cm) show suboptimal patency rates of 33% at one year. Methods Two hundred eighty-seven patients (mean age 68 years, 66% male) were treated with the EverFlex™ Self-Expanding Peripheral Stent System. Patients were followed through 3 years with yearly core lab adjudicated duplex ultrasonography for patency, radiographic assessment of stent fractures, and resting ankle brachial indices. Results Overall freedom from loss of primary patency at 3 years was 60.0%. Patency was significantly higher for lesions ≤8 cm compared with lesions >8 cm (71.0 vs. 50.5%, P

The presence of bio lm remains a challenging factor that contributes to the delayed healing of many chronic wounds. The major threat of chronic wound bio lms is their substantial protection from host immunities and extreme tolerance to antimicrobial agents. To help guide the development of wound treatment strategies, a panel of experts experienced in clinical and laboratory aspects of biofilm convened to discuss what is understood and not yet understood about biofilms and what is needed to better identify and treat chronic wounds in which biofilm is suspected. This article reviews evidence of the problem of biofilms in chronic wounds, summarizes literature-based and experience-based recommendations from the panel meeting, and identities future and emerging technologies needed to address the current gaps in knowledge. While currently there is insufficient evidence to provide an accurate comparison of the effectiveness of current therapies/products in reducing or removing biofilm, research has shown that in addition to debridement, appropriate topical antimicrobial application can suppress biofilm reformation. Because the majority of the resistance of bacteria in a biofilm population is expressed by its own secreted matrix of extracellular polymeric substance (EPS), panel members stressed the need for a paradigm shift toward biofilm treatment strategies that disrupt this shield. High-osmolarity surfactant solution technology is emerging as a potential multimodal treatment that has shown promise in EPS disruption and prevention of biofilm formation when used immediately post debridement. Panel members advocated incorporating an EPS-disrupting technology into an antibiofilm treatment approach for all chronic wounds. The activity of this panel is a step toward identifying technology and research needed to improve biofilm management of chronic wounds.

Standard negative pressure wound therapy (NPWT) has been shown to help close wounds despite increasing planktonic bioburden. Both planktonic and biofilm critical colonization are associated with delayed wound healing; therefore, reducing microbial colonization is thought to aid wound healing. The use of NPWT with topical antimicrobial irrigation solution has previously shown reduction in quantitative planktonic bioburden when combined with sharp debridement in chronic wounds.The goal of this study was to evaluate the effectiveness of NPWT with instillation (NPWTi) on biofilm of chronic wounds.A prospective, randomized trial was conducted. Following sharp debridement, 20 patients with chronic wounds were randomized to 1 week of either NPWTi with 0.125% sodium hypochlorite solution (n = 10) or NPWT without instillation (n = 10). Serial wound biopsy was performed predebridement, postdebridement, and after 1 week of study therapy to test for quantitative nonplanktonic or biofilm-protected bacteria.As expected, there was no difference in change in wound size between the 2 groups at 1 week. The NPWTi group had a mean reduction in quantitative biofilm-protected bacteria of 48%, while the NPWT without instillation group had a mean increase of 14% (P.05).Consistent with previous studies, this trial demonstrates that NPWTi with dilute sodium hypochlorite solution is effective at reducing nonplanktonic bioburden of chronically, critically colonized wounds.Therefore, based on this and previously published work, this therapy provides both planktonic and nonplanktonic bioburden reduction as well as NPWT benefits and may be a tool for the preparation of infected wound beds prior to definitive closure.

Supplemental Digital Content is available in the text., Background: Drug-coated balloons (DCBs) are a predominant revascularization therapy for symptomatic femoropopliteal artery disease. Because of the differences in excipients, paclitaxel dose, and coating morphologies, varying clinical outcomes have been observed with different DCBs. We report the results of 2 studies investigating the pharmacokinetic and clinical outcomes of a new DCB to treat femoropopliteal disease. Methods: In the ILLUMENATE Pivotal Study (Prospective, Randomized, Single-Blind, U.S. Multi-Center Study to Evaluate Treatment of Obstructive Superficial Femoral Artery or Popliteal Lesions With A Novel Paclitaxel-Coated Percutaneous Angioplasty Balloon), 300 symptomatic patients (Rutherford class 2–4) were randomly assigned to DCB (n=200) or standard angioplasty (percutaneous transluminal angioplasty [PTA]) (n=100). The primary safety end point was freedom from device- and procedure-related death through 30 days, and freedom from target limb major amputation and clinically driven target lesion revascularization through 12 months. The primary effectiveness end point was primary patency through 12 months. In the ILLUMENATE PK study (Pharmacokinetic Study of the Stellarex Drug-Coated Angioplasty Balloon), paclitaxel plasma concentrations were measured after last DCB deployment and at prespecified times (at 1, 4, 24 hours and at 7 and 14 days postprocedure) until no longer detectable. Results: In the ILLUMENATE Pivotal Study, baseline characteristics were similar between groups: 50% had diabetes mellitus, 41% were women, mean lesion length was 8.3 cm, and 44% were severely calcified. The primary safety end point was met (92.1% for DCB versus 83.2% for PTA, P=0.025 for superiority) and the primary patency rate was significantly higher with DCB (76.3% for DCB versus 57.6% for PTA, P=0.003). Primary patency per Kaplan-Meier estimates at day 365 was 82.3% for DCB versus 70.9% for PTA (P=0.002). The rate of clinically driven target lesion revascularization was significantly lower in the DCB cohort (7.9% versus 16.8%, P=0.023). Improvements in ankle-brachial index, Rutherford class, and quality of life were comparable, but the PTA cohort required twice as many revascularizations. Pharmacokinetic outcomes showed that all patients had detectable paclitaxel levels after DCB deployment that declined within the first hour (54.4±116.9 ng/mL to 1.4±1.0 ng/mL). Conclusions: The data demonstrate superior safety and effectiveness of the Stellarex DCB in comparison with PTA, and plasma levels of paclitaxel fall to low levels within 1 hour. Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifiers: NCT01858428 and NCT01912937.

Non-thermal gas plasmas (NTGPs) are a promising emergent medical technology.a Unlike thermal plasmas, they generate a complex room temperature mix of reactive species which interact with tissues. The characterization of candidate plasmas and their interaction with tissues has shown that they produce a variety of broadly dose dependent effects ranging from fibroblast proliferation to angiogenesis and bacterial destruction. These findings, supported by recent experiments using skin models, suggest that NTGP's could potentially play an important role in both decontaminating acute and chronic wounds and accelerating healing. However, important issues over toxicological and environmental safety remain unanswered and a number of regulatory and technical hurdles will need to be overcome before a NTGP medical device is released.

Background Previously, the Stenting and Angioplasty with Protection of Patients with High Risk for Endarterectomy (SAPPHIRE) randomized trial showed that carotid artery stenting (CAS) was not inferior to carotid endarterectomy (CEA) in the treatment of high-surgical risk patients. Objective The primary objective of the SAPPHIRE Worldwide Registry is to evaluate 30-day major adverse events (MAE) after CAS performed by physicians with varied experience and utilizing a formal training program. Data will be analyzed on the overall patient population and by high-risk inclusion criteria. Methods SAPPHIRE Worldwide is a multicenter, prospective, postapproval registry to evaluate CAS with distal protection in patients at high-risk for surgery using the Cordis PRECISE Nitinol Stent and ANGIOGUARD™ XP/RX Emboli Capture Guidewire. Participating physicians are encouraged to treat patients according to their standard of practice and consistent with current Food and Drug Administration-approved labeling. Results Enrollment began in October 2006. Data are available on the first 2,001 patients enrolled and followed to 30 days. Of these patients, the mean age was 72.2 ± 9.75 yr; 62% were male; and 27.7% were symptomatic. Entry criteria for surgical high-risk included anatomic (n = 716), physiologic (n = 918), or both risk factors (n = 327). At 30-day follow-up, the MAE was 4.4% (death 1.1%, stroke 3.2%, MI 0.7%) for the overall population. Patients with anatomic risk had a significantly lower 30-day MAE than patients with physiologic risk (2.8% vs. 4.9%, P = 0.0306), respectively. Conclusions While the number of physicians performing CAS continues to increase, MAE rates seen in this registry (4.4%) are well within an acceptable range, as was first seen in the SAPPHIRE randomized trial (4.8%). A significant decrease in MAE was seen in patients with anatomic risk compared with physiologic risk factors. The SAPPHIRE Worldwide Registry supports the use of CAS as an alternative to CEA in patients who are at high-risk for surgery due to anatomic risk factors. © 2008 Wiley-Liss, Inc.

Augmented expression of connective tissue growth factor (CTGF/CCN2) is observed in healing wounds and in a variety of fibrotic disorders. It appears to enhance many of the effects of transforming growth factor-beta and has been shown to have independent fibrogenic functions. Despite these observations, its importance to dermal wound healing and the transition from wound to scar remains poorly defined. In this study, we use established rabbit models to evaluate the roles of CTGF in dermal wound healing and hypertrophic scarring. We show that CTGF mRNA demonstrates persistent up-regulation in hypertrophic scars. Treatment of wounds with antisense oligonucleotides to CTGF has no measurable effect on early wound closure. However, antisense therapy significantly limits subsequent hypertrophic scarring. Inhibition of CTGF is associated with a marked reduction in the number of myofibroblasts in scars and decreased transcription of TIMP-1 and types I and III collagen. These findings confirm CTGF to be a key mediator of hypertrophic scarring in this model. Its effect on myofibroblasts in this setting suggests a mechanism whereby it plays this role. Its limited participation in early healing implies that it may be a useful and specific target for modulating hypertrophic scarring following injury.

Introduction: Negative pressure wound therapy (NPWT) is an established treatment of chronic wounds. There is limited understanding of the molecular biological mechanisms of NPWT. The purpose of this study was to characterize changes in the biochemical composition of wound fluid collected from chronic pressure ulcer wounds in adults treated with NPWT. Methods: Nine stage III or IV pressure ulcer patients scheduled for NPWT (V.A.C.® Therapy, KCI, San Antonio, TX) were recruited. Their ages ranged between 30 and 99. Concentrations of cytokines (IL-1β, TNF-α), metalloproteinases (MMP-2, MMP-3), and tissue inhibitor of metalloproteinase (TIMP)-1 in wound fluids were measured at baseline and after 1 day, 3 days, and 7 days of continuous NPWT. Results: At days 1, 3, and 7, TNF-α levels were significantly and comparably lower than baseline (p

Bacterial growth within extended use wound dressings remains a problem. We have developed a superabsorbent, microbicidal dressing based on the permanent attachment of a cationic polymer (the quaternary ammonium compound diallyl dimethyl ammonium chloride, DADMAC) onto a range of physical substrates. Treated gauze (Sof-Wick™) absorbed 50x its weight in saline and reduced bacterial, viral and fungal growth by six logs in vitro (AATCC method 100), with no zone of inhibition or extractables, as shown in Figure 1 below. Bacterial kill occurs within minutes, and remains effective in 10% serum. Good hemostatic properties were demonstrated for treated gauze wound dressing using both a rat liver laceration model, and a renal artery transection model, showing equivalent efficacy to approved haemorrhage control dressings (Avitene, Surgicel, and Gel Foam) that do not claim microbicidal activity. Treated gauze passed cytotoxicity testing using rabbit eye and skin tests, as well as guinea pig dermal sensitization tests. Figure 1. Gauze sponges inoculated with E. Coli and stained for bacterial presence. Left is control; right is NIMBUS treated. Note no zone of inhibition around treated gauze. Acknowledgment: This research was supported by QuickMed Technologies.

It has been postulated that elevated levels of matrix metalloproteinases (MMPs) and reactive oxygen species detected in fluids and biopsies of chronic wounds contribute to the failure of wound to heal by degrading essential growth factors, receptors and extracellular matrix proteins. This stimulated the development of a formulation containing metal ions (polyhydrated ionogen or PHI) and citric acid that reduced reactive oxygen species in cultures of polymorphonuclear leukocytes (J Wound Care 12:10, 2003). The effect of PHI on synthesis of MMPs was studied in cultures of tumor cells and human dermal fibroblasts. Dose response curves of PHI ranging from 0.02% to 10%(W/V) established no toxicity in cultures of human dermal fibroblasts after 24 hours of incubation with PHI at concentrations below 1.25%, as measured by MTT assay. Levels of MMP-2 activity measured by antibody capture assay were reduced approximately 80% in culture medium of Mor-86 glioma tumor cells after 24 hours of exposure to 1% PHI. These results suggest that PHI reduced the synthesis of MMP-2 protein, presumably by reducing transcription and/or translation of MMP-2 gene. Clinical case reports of chronic wounds treated by PHI dressing (DerMax) suggest that PHI treatment stimulated healing and reduced MMP-2 immunostaining in biopsies of the chronic wounds. Acknowledgment: This research was supported by Greystone Medical Group.

Introduction: Compelling evidence suggests that nitric oxide (NO•) plays an important role in wound healing. Not only does it possess cytotoxic properties, but also regulatory functions on various cells involved in inflammation and proliferation. In wounds, inducible NO synthase (iNOS) catalyzes arginine to citrulline and NO•, whereas arginase converts arginine to ornithine and urea. Ornithine is an essential substrate for the synthesis of polyamines, which are important in cellular proliferation and repair. A model for regulation of wound healing proposes the importance of a strict reciprocal control of these enzymes in wounds. Human studies using impaired wound healing models, however, are lacking in this area. Thus, the purpose of this study was to investigate arginine metabolism in wound fluids of patients with pressure ulcers on Vacuum Assisted Closure (V.A.C.®) therapy. Methods: Wound fluid extracts from 11 patients with stage III or IV pressure ulcer were analyzed for cytokines and metabolites of arginine. Sample age ranged from 31–92 years. Wound fluid was collected prior to V.A.C.® application and post-V.A.C.® within 24 hours, 3 days, and 7 days. Subjects served as their own control in this quasi-experimental repeated measures design. Spectrophotometric quantification of nitrates and nitrites using the Griess diazotization reaction method was performed. Tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) concentrations were measured by enzyme-linked immunosorbent assay. Levels of arginine, citrulline, ornithine, and proline were analyzed by high performance liquid chromatography. Results: There was no significant differences between pre- and post-V.A.C.® concentrations of NO•, citrulline, ornithine, and proline. However, there was a statistically significant decrease in arginine levels measured at baseline and day'3 of V.A.C.® treatment. Also, NO• measured at 24 hours of V.A.C.® placement decreased significantly at day 7 of therapy. Furthermore, post-V.A.C.® levels of TNF-α decreased significantly from baseline. A less cytotoxic environment is created, thus indicating a healing wound following 1 week of V.A.C.® therapy. Discussion: Arginine and its metabolites are detectable in wound fluids from patients with pressure ulcers. To our knowledge, the metabolism of arginine has not been described in human subjects with pressure ulcers on V.A.C.® therapy. The determination of NO• in these wound environments provides baseline information on the mechanisms involved in aberrant wound healing.

Background This article presents an endovascular approach to repair a unilateral or bilateral aortoiliac aneurysm with a bifurcated iliac limb that can maintain perfusion to the internal iliac artery (IIA) bilaterally through a brachial access. Methods A standard infrarenal aortic aneurysm repair is performed followed by iliac aneurysm exclusion. To obtain exclusion in the common iliac artery aneurysm, a bifurcated Endurant iliac limb is modified to compartmentalize iliac flow 2–3 cm above the internal iliac ostia. Then, a balloon-expandable covered stent graft is used to achieve sealing in the IIA and external iliac artery (EIA). The IIA is stented from the arm and the EIA is stented from the groin. Results There was no in-hospital or 30-day mortality. The procedural design was followed in each of the patients who received treatment. Technical success was 100%, short-term clinical success was 92%, and midterm clinical success was 83%. Average dosage of contrast medium was 116 mL (range, 55–193 mL), and average fluoroscopy time was 42.1 min (range, 20.8–91.6 min). Average length of hospital stay was 2.6 days (range, 1–9 days). There was 1 recorded endoleak. No reports of gluteal claudication, sexual dysfunction, or bowel or spinal claudication have been found. Conclusions The technique described here does not require an up-and-over approach, allowing simplified bilateral repair. Although this is a promising technique, long-term durability needs to be evaluated in a controlled prospective study.

We present spatially separated optical spectra of the components of the young hierarchical quadruple GG Tau. Spectra of GG Tau Aa and Ab (separation 0".25 ~ 35 AU) were obtained with the Faint Object Spectrograph aboard the Hubble Space Telescope. Spectra of GG Tau Ba and Bb (separation 1".48 ~ 207 AU) were obtained with both the HIRES and the LRIS spectrographs on the W. M. Keck telescopes. The components of this mini-cluster, which span a wide range in spectral type (K7 - M7), are used to test both evolutionary models and the temperature scale for very young, low mass stars under the assumption of coeval formation. Of the evolutionary models tested, those of Baraffe et al. (1998, A&A, 337, 403) yield the most consistent ages when combined with a temperature scale intermediate between that of dwarfs and giants. The version of the Baraffe et al. models computed with a mixing length nearly twice the pressure scale height is of particular interest as it predicts masses for GG Tau Aa and Ab that are in agreement with their dynamical mass estimate. Using this evolutionary model and a coeval (at 1.5 Myrs) temperature scale, we find that the coldest component of the GG Tau system, GG Tau Bb, is substellar with a mass of 0.044 +/- 0.006 Msun. This brown dwarf companion is especially intriguing as it shows signatures of accretion, although this accretion is not likely to alter its mass significantly. GG Tau Bb is currently the lowest mass, spectroscopically confirmed companion to a T Tauri star, and is one of the coldest, lowest mass T Tauri objects in the Taurus-Auriga star forming region., 25 pages, 6 figures, accepted for publication in The Astrophysical Journal

Remotely-Operated Vehicles (ROVs) serve many functions during site characterization surveys including dive team assistance, quality control, and anomaly reacquisition. Reacquisition applications require detection, geo-registration, and investigation of items of interest located on, or below, the seafloor. Underwater target detection using ROVs poses many challenges. Detection sensors must be mounted far enough away from the vehicle to reduce noise effects from thrusters and other vehicle sensors. Conversely, detection sensors must be mounted close enough to the vehicle to maintain vehicle maneuverability. Vehicle noise characterization with respect to sensor standoff and orientation is discussed. ROV applications require the collection of correlated detection sensor data along with global position information. Positional accuracy varies depending on the method used and can be dependent on site and deployment conditions. Positioning systems, including Ultra-Short Base Line (USBL), Doppler Velocity Logs (DVL), and Real-time Kinematic Global Positioning System (RTK-GPS) are discussed with respect to underwater object localization. We present the development of underwater metal detection systems consisting of magnetometer and electromagnetic induction (EMI) sensors mounted on a mini-ROV. Detection sensors include fluxgate magnetometers and a diver handheld EMI sensor modified for data transmission through the ROV umbilical for digital data capture and audio data delivery topside. Sensor sensitivities are defined through analysis of data collected against targets of various sizes. We discuss the development, performance, and operation of various payloads for different applications and compare ROV and dive team results and efficiency.

In this paper we describe a successful model of underwater munitions characterization using a suite of integrated technologies. Adapted from mature and extensively utilized land-based munitions assessment techniques, a comprehensive suite of technologies are employed. Project phases and technologies include; diver reconnaissance utilizing former Navy EOD personnel, multi-beam sonar for bathymetry, side scan sonar for seafloor target detection and classification, sub-bottom profiling for sediment characterization, stationary scanning sonar to define high resolution bottom conditions, diver visual searches, full-coverage geophysical mapping via vessel-deployed magnetometer arrays, remote operated vehicle (ROV) deployments for visual and sonar searches and target interrogation, and ROVs equipped with an electromagnetic induction sensor array for target detection and interrogation. Additionally, three integrated underwater positioning systems were used to support accurate collection and integration of datasets within a comprehensive on-site GIS. Application of the methodology at two sites will be discussed. The first site in Seattle Washington comprised a highly cluttered environment around a working pier with water depths between 12 and 21 m. The second site comprises 1170 Ha at a former aerial bombing range at Choctawhatchee Bay near Pensacola, FL with water depths from 1 to 12 m with moderate currents.

High-resolution light detection and ranging (LiDAR) systems generate bare-earth and surface digital elevation models (DEMs) identifying a broad range of subtle ground features. Unfortunately, to create a DEM from airborne data collections involves a computationally intensive post-processing step typically performed on the ground.

Pressure ulcer assessment is usually performed at the bedside by a clinician with minimal training in wound assessment. A multidisciplinary panel of United States' wound experts was assembled to provide anatomically accurate and practical terms associated with pressure ulcer assessment, healing, and nonhealing in order to help clinicians identify and describe tissue types and pressure ulcer stages. Specifically, anatomical markers and/or structures within the wound are described to facilitate tissue type identification and pressure ulcer staging. The panel agreed that the provision of a common language facilitates quality care across settings. Although some research has been conducted, additional studies to determine the validity and reliability of wound assessment and healing terms and definitions, as well as pressure ulcer staging systems, are needed.

In October 2005, the IBM Human Ability and Accessibility Center and T.J. Watson Research Center hosted a symposium on “cognitive and learning difficulties and how they affect access to IT systems”. The central premise of the symposium was the recognition that cognitive and learning difficulties have a profound impact on a person’s ability to interact with information technology (IT) systems, but that little support is currently being offered by those systems. By bringing together internationally renowned experts from a variety of different, but complementary, research fields, the symposium aimed to provide a complete overview of the issues related to this topic. This paper summarises the discussions and findings of the symposium.

We have obtained intermediate resolution spectra of eleven candidate brown dwarf members of the Pleiades open cluster using the Keck II telescope and LRIS spectrograph. Our primary goal was to determine the location of the "lithium depletion edge" in the Pleiades and hence to derive a precise age for the cluster. All but one of our 11 program objects have radial velocities appropriate for Pleiades members, have moderately strong H alpha emission, and have spectral types M6 to M8.5, as expected for their (R-I) colors. We have constructed a color-magnitude diagram for the faint end of the Pleiades main sequence, including only stars for which high S/N spectra in the region of the lithium 6708 Angstrom absorption line have been obtained. These data allow us to accurately determine the Pleiades single-star lithium depletion edge at I(c0) = 17.80, R-I(c0) = 2.20, spectral type = M6.5. By reference to theoretical evolutionary models, this converts fairly directly into an age for the Pleiades of 125 Myr. This is significantly older than the age that is normally quoted, but does agree with some other recent estimates., Comment: 12 pages, including 3 Figures. Accepted by ApJ Letters

Engineers at the U.S. Army Aberdeen Test Center (ATC) currently are planning to adopt and expand upon a vehicle simulation concept used in the automotive industry. This effort will further enhance the ATC standing as a leader in the automotive testing arena. Greg A. Schultz, chief of ATC's Instrumentation Applications Branch, says that ATC is studying the innovative design of MTS Systems Corporation, a Minnesota-based engineering firm. MTS engineers are pioneers in development of hardware in the loop simulations for commercial automobiles. MTS uses the Flat Trac-R Roadway Simulator, a technology which may enable testing of the largest military trucks, allowing many of the tests performed on the proving ground test tracks to be performed under the controlled conditions of the laboratory.

Introduction: Percutaneous balloon mitral valvuloplasty (PBMV) is a well-established alternative to commissurotomy and is recommended for patients with Mitral stenosis (MS) and echocardiographic (ECHO) score b8 and no calcified mitral valves. However, the question remains whether simultaneous intracardiac echocardiography (ICE) is useful to perform PBMV in suboptimal candidates without provoking excessive mitral regurgitation (MR). Materials and Methods: Fifty-seven consecutive PBMV procedures under ICE guidance were performed under local anesthesia and mild sedation between May 2004 and October 2008 at University of Alabama at Birmingham. Left femoral vein was used for ICE insertion while the right was used for transseptal access. Transthoracic echocardiography was used to assess the mitral valve pre and post PBMV. The corresponding preand postPBMVmitral valve areas (MVA) were calculated. Inhospital adverse clinical events were collected. Results: There were 10 (18%) men. The mean age was 53.9±14 years (range, 26–94 years). Two thirds had ECHO score N8, and 33% had moderate to severe MR before PBMV. After PBMV, MVA increased from 1.1±0.29 cm to 1.8±0.9 cm (Pb.005) by planimetry, from 1.25±0.58 cm to 1.97±0.57 cm (Pb.005) by Gorlin's formula. The mean mitral valve gradient decreased from 14±5 mm Hg to 7±3 mm Hg (Pb.005). None had cardiac tamponade or died during the procedure. Fifty-two patients (91.2%) had successful PBMV without in-hospital adverse events. Three (5.2%) required MVR. Two patients developed flail MV leaflet due to rupture of chordae. The third with Grade 3 MR prior to PBMV had progressively worsening symptoms for 7 days requiring MVR. One patient, with prePBMV valve area of 0.6 cm had improvement in MVA to 1.4 cm but developed MRSA sepsis and acute renal failure, which resolved during her hospital stay. Conclusion: MS patients with poor MVanatomy and moderate to high risk for PBMV have been traditionally relegated to medical therapy. With ICE guidance, PBMV can be extended to these patients with unsuitable MV anatomy with reasonable procedural success and safety. To our knowledge, this is the largest case series reporting the use of ICE to facilitate PBMV in such moderate to high-risk patients

Purpose: To evaluate expression patterns of protein kinases and protein kinase activities in human corneal fibroblasts treated with connective tissue growth factor (CTGF). Methods: Human corneal fibroblast cultures were grown to confluence and treated with CTGF for 0, 5, and 15 minutes. Cytoplasmic protein extracts were obtained; protein kinase expression and activity arrays were performed using Kinetworks™ analysis (screening for expression of 75 different protein kinases and 31 different phosphoproteins). Further studies using extended time courses of CTGF exposure in corneal fibroblasts (0, 1, 2, 3, 4, 5, 10, 15, 30, and 60 minutes) were performed using immunoblot analysis to detect expression of protein kinase A catalytic subunit (PKA-cat), and focal adhesion kinase (FAK). All results and were normalized by comparison to beta-actin. Results: After 5 minutes of exposure to CTGF, levels of active proteins increased for 21 of the 75 kinases analyzed. Some notable protein kinases that were induced include: death-associated kinase 1, focal adhesion kinase (FAK), G-protein coupled receptor kinase 2, protein kinase A catalytic subunit (PKA-cat), protein kinase B alpha, and protein kinase C (e, μ, and ζ, subunits). Extended time course analysis of PKA-cat and FAK showed statistically significant increases in expression following CTGF stimulation within 15 minutes. Conclusion: CTGF increased the levels of active protein kinases in human corneal fibroblast cultures, including PKA-cat and FAK after 5 minutes of exposure. These results further our understanding of the signal transduction mechanism activated by CTGF in corneal fibroblasts. This suggests that CTGF mediates the effects of transforming growth factor beta (TGF-β) on protein kinase expression and phosphorylation of second messengers in processes such as cell proliferation and collagen synthesis. Acknowledgments: Funding source: NEI 05587