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Froese and Pauly argue that our model is contradicted by the observation that fish reproduce before their growth rate decreases. Kearney and Jusup show that our model incompletely describes growth and reproduction for some species. Here we discuss the costs of reproduction, the relationship between reproduction and growth, and propose tests of models based on optimality and constraint.

Purpose This study compared the in vitro/benchtop and in vivo mechanical properties and host biologic response to ovine rumen-derived/polymer mesh hybrid OviTex™ with porcine-derived acellular dermal matrix Strattice™ Firm. Methods OviTex 2S Resorbable (OviTex 2S-R) and Strattice morphology were examined in vitro using histology and scanning electron microscopy; mechanical properties were assessed via tensile test; in vivo host biologic response and explant mechanics were evaluated in a rodent subcutaneous model. Separately, OviTex 1S Permanent (OviTex 1S-P) and Strattice were evaluated in a primate abdominal wall repair model. Results OviTex 2S-R demonstrated layer separation, whereas Strattice retained its structural integrity and demonstrated higher maximum load than OviTex 2S-R out-of-package (124.8 ± 11.1 N/cm vs 37.9 ± 5.5 N/cm, p p p = 0.003), and 72 h (29.2 ± 10.5 N/cm vs 3.2 ± 3.1 N/cm, p = 0.006) following collagenase digestion. In rodents, inflammatory cell infiltration was observed between OviTex 2S-R layers, while Strattice induced a minimal inflammatory response. Strattice retained higher maximum load at 3 (46.3 ± 27.4 N/cm vs 9.5 ± 3.2 N/cm, p = 0.041) and 6 weeks (28.6 ± 14.1 N/cm vs 7.0 ± 3.0 N/cm, p = 0.029). In primates, OviTex 1S-P exhibited loss of composite mesh integrity whereas Strattice integrated into host tissue with minimal inflammation and retained higher maximum load at 1 month than OviTex 1S-P (66.8 ± 43.4 N/cm vs 9.6 ± 4.4 N/cm; p = 0.151). Conclusions Strattice retained greater mechanical strength as shown by lower susceptibility to collagenase degradation than OviTex 2S-R in vitro, as well as higher maximum load and improved host biologic response than OviTex 2S-R in rodents and OviTex 1S-P in primates.

Figure S1. Squamous cell carcinoma formation and survival in Fancc-/- and wild type mice

Legends for supplementary figures and table

Table S1. Analyses and crosslinker sensitivity of murine Fancc and wild type cell lines

Figure S2. Crosslinker and chemotherapy sensitivity of human FA-deficient and -proficient HNSCC lines

Supplementary Materials and Methods. Details on experimental approaches and reagents that were utilized

Purpose: Fanconi anemia is an inherited disorder associated with a constitutional defect in the Fanconi anemia DNA repair machinery that is essential for resolution of DNA interstrand crosslinks. Individuals with Fanconi anemia are predisposed to formation of head and neck squamous cell carcinomas (HNSCC) at a young age. Prognosis is poor, partly due to patient intolerance of chemotherapy and radiation requiring dose reduction, which may lead to early recurrence of disease.Experimental Design: Using HNSCC cell lines derived from the tumors of patients with Fanconi anemia, and murine HNSCC cell lines derived from the tumors of wild-type and Fancc−/− mice, we sought to define Fanconi anemia–dependent chemosensitivity and DNA repair characteristics. We utilized DNA repair reporter assays to explore the preference of Fanconi anemia HNSCC cells for non-homologous end joining (NHEJ).Results: Surprisingly, interstrand crosslinker (ICL) sensitivity was not necessarily Fanconi anemia–dependent in human or murine cell systems. Our results suggest that the increased Ku-dependent NHEJ that is expected in Fanconi anemia cells did not mediate relative ICL resistance. ICL exposure resulted in increased DNA damage sensing and repair by PARP in Fanconi anemia–deficient cells. Moreover, human and murine Fanconi anemia HNSCC cells were sensitive to PARP inhibition, and sensitivity of human cells was attenuated by Fanconi anemia gene complementation.Conclusions: The observed reliance upon PARP-mediated mechanisms reveals a means by which Fanconi anemia HNSCCs can acquire relative resistance to the ICL-based chemotherapy that is a foundation of HNSCC treatment, as well as a potential target for overcoming chemoresistance in the chemosensitive individual. Clin Cancer Res; 21(8); 1962–72. ©2015 AACR.

Figure S4. PARP inhibitor sensitivity of human and murine HNSCC cells

We use a general equilibrium model to show that a decrease in workers’ bargaining power amplifies the contribution to the output gap of adjustments along the extensive versus intensive margin of labour utilization. Under standard assumptions on the disutility of labour, this mechanism reduces the cyclical movements of inflation relative to those of the output gap. Micro-level evidence, based on a survey of Italian firms, provides support to the relationship between bargaining power and adjustments along the extensive margin versus the intensive one, as well as to attenuated price response when firms adjust labour input mainly through the extensive margin. A Bayesian estimation using Italian aggregate data for the samples 1970–1990 and 1991–2014 confirms that the decline in workers’ bargaining power has weakened the inflation–output gap relationship.

The primary objective of this retrospective study is to compare patient outcomes following a combined approach (MPFL reconstruction and TTT) to outcomes reported in the literature by patients who required either only an isolated TTT procedure to treat pathologic lateral patellar instability or isolated MPFL reconstruction to treat patellar dislocation due to MPFL insufficiency. Twenty-three patients (74%) were available for follow-up and are included in our analysis. MPFL reconstruction combined with TTT has a high rate of success for patients presenting with patellar instability and extensor mechanism mal-alignment. The risk of recurrence with this technique was low (4.3%).

Background Hospitalization for persons with inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a significant contributor to morbidity and health care costs in Canada. Recognition of individuals at high risk of re-hospitalization could help inform targeted outpatient interventions that mitigate this risk. Purpose The aim of our study is to derive prediction models of risk of early (90-day) re-hospitalization among persons with IBD. Method We conducted a retrospective cohort study of all adult persons with IBD admitted to The Ottawa Hospital, Canada, for an acute IBD-related indication between April 2009 - March 2016. Demographic, clinical, and health services variables were obtained through chart review. Persons were linked to population-based health administrative datasets to identify historical and future IBD-related hospitalizations across the greater Ottawa region. Multivariable logistic regression models of 90-day re-hospitalization in persons with CD and UC were derived, and candidate predictors that demonstrated an independent association with the outcome at a p-value of 0.1 were retained. Bootstrap internal validation (200 iterations) was performed on the final models. Model performance and calibration were evaluated using the optimism-corrected c-statistic value and Hosmer-Lemeshow goodness of fit test, respectively. Adjusted odds ratios are reported with 95% confidence intervals (CI). Optimal probability cut points for re-hospitalization were selected to optimize sensitivity, specificity, and the J (Youden’s) index. Result(s) There were 524 CD and 248 UC hospitalizations during the study period. Of these, 57 (10.9%) CD and 27 (10.9%) UC hospitalizations were associated with re-hospitalization within 90 days of discharge. Forty-two candidate predictors were tested among CD hospitalizations, and 35 were tested among UC hospitalizations. Four variables were retained in each of the final models. Model performance and calibration for each variable are described in Table 1. The optimal range of probability cut points allowed for a sensitivity/positive predictive value (PPV)/false positive rate (FPR) of 0.72/0.23/0.29 (maximum J-index of 0.43) in the model for CD, and 0.78/0.33/0.19 (maximum J-index of 0.59) in the model for UC, respectively. Image Conclusion(s) Demographic, clinical, and health services variables at the time of discharge have the potential to help identify persons with IBD at risk of early re-hospitalization, thereby permitting targeted outpatient intervention. Application of the models to our reference cohorts would earmark 1/3 or less of patients for early post-discharge intervention, with the potential to benefit more than 70% of patients destined for early re-hospitalization. Although the PPVs of our models were low, the models incorrectly predicted early re-hospitalization in less than 30% of patients. We are in process of externally validating these models in other jurisdictions across Ontario to test their generalizability. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Organisms use energy to grow and reproduce, so the processes of energy metabolism and biological production should be tightly bound. On the basis of this tenet, we developed and tested a new theory that predicts the relationships among three fundamental aspects of life: metabolic rate, growth, and reproduction. We show that the optimization of these processes yields the observed allometries of metazoan life, particularly metabolic scaling. We conclude that metabolism, growth, and reproduction are inextricably linked; that together they determine fitness; and, in contrast to longstanding dogma, that no single component drives another. Our model predicts that anthropogenic change will cause animals to evolve decreased scaling exponents of metabolism, increased growth rates, and reduced lifetime reproductive outputs, with worrying consequences for the replenishment of future populations.

Background Proton pump inhibitors (PPIs) are commonly prescribed medications which are indicated in various different gastrointestinal (GI) diseases, including peptic ulcer disease, gastroesophageal reflux disorder and upper GI bleeding. There is some evidence to suggest that PPI use in cirrhosis may predispose to the development of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), albeit with some controversy. Aims We aim to conduct a retrospective epidemiological analysis of the association between PPI use in hospitalized patients with cirrhosis and prevalence of HE and SBP. Methods This was a retrospective cohort study of 953 adult patients (mean age 62.3 (SD=12.2)) with cirrhosis admitted to the Ottawa Hospital between January 1, 2011 and December 31, 2015. A chart review was conducted and relevant information extracted. Results Average MELD-Na on admission was 17.4 (SD = 7.5) with no significant differences when stratified by in-hospital PPI use (p=0.53). 14.7% of patients had a prior history of HE, 5.4% SBP, 31.6% ascites, 9.3% hepatocellular carcinoma and 1.2% hepatorenal syndrome. 26.4% of patients had a history of varices, of which 34.4% had previous variceal bleeding. 45.4% of patients were on a PPI prior to admission and 69.8% during their hospitalization. Patients with a previous history of HE (16.8% vs. 9.6% p=0.006), varices (31.4% vs. 14.2% p There was no significant association noted between the incidence of HE (31.2% vs. 25.0% p=0.06) or SBP (10.4% vs. 8.0% p=0.25) and in-hospital PPI use. There was also no significant association between PPI use and infectious complications, including bacteremia (8.6% vs. 7.6% p=0.63), pneumonia (12.7% vs. 12.5% p=0.95), urinary tract infections (9.2% vs. 6.6% p=0.19) and clostridium difficile (3.8% vs. 2.1% p=0.18). Patients on a PPI had greater in-hospital mortality (22.0% vs. 13. 5% p=0.002), although there was no significance between cause of death (p=0.31) nor death from infectious complications (18.5% vs. 23.1% p=0.52) between groups. Length of stay (LOS) was longer in patients exposed to PPI (median (IQR) 7 (4–17) vs 6 (3–13) p=0.03). Similar findings were noted on subgroup analysis of decompensated patients. Conclusions We did not observe a significant difference in HE, SBP or infectious complications among this cohort of cirrhotic patients by in-hospital PPI use. However, there was a significantly higher mortality rate noted in hospital and longer LOS, despite similar baseline MELD-Na and causes of death. Further study and judicious PPI prescribing practices in this vulnerable population of patients is warranted. Funding Agencies None

The airborne fungus Aspergillus fumigatus poses a serious health threat to humans by causing numerous invasive infections and a notable mortality in humans, especially in immunocompromised patients. Mould-active azoles are the frontline therapeutics employed to treat aspergillosis. The global emergence of azoleresistant A. fumigatus isolates in clinic and environment, however, notoriously limits the therapeutic options of mould-active antifungals and potentially can be attributed to a mortality rate reaching up to 100 %. Although specific mutations in CYP51A are the main cause of azole resistance, there is a new wave of azole-resistant isolates with wild-type CYP51A genotype challenging the efficacy of the current diagnostic tools. Therefore, applications of whole-genome sequencing are increasingly gaining popularity to overcome such challenges. Prominent echinocandin tolerance, as well as liver and kidney toxicity posed by amphotericin B, necessitate a continuous quest for novel antifungal drugs to combat emerging azole-resistant A. fumigatus isolates. Animal models and the tools used for genetic engineering require further refinement to facilitate a better understanding about the resistance mechanisms, virulence, and immune reactions orchestrated against A. fumigatus. This review paper comprehensively discusses the current clinical challenges caused by A. fumigatus and provides insights on how to address them.

Summary DAOS-SEIS mapping layer is introduced to the seismic community, utilizing the evolving DAOS technology, to solve some of the seismic IO bottlenecks caused by the SEGY data format through leveraging the graph theory in addition to the DAOS object-based storage to design and implement a new seismic data format natively on top of the DAOS storage model in order to accelerate data access, provide in-storage compute capabilities to process data in place and to get rid of the serial seg-y file constraints. The DAOS-SEIS API is built on top of the DAOS file system(dfs) and seismic data is accessed and manipulated using the DAOS-SEIS API after accessing the root seismic dfs object. The mapping layer is perfectly utilizing the graph theory and the object storage to split the acquisition geometry represented by the traces headers away from the time-series data samples

Individualized parenteral nutrition is frequently used in neonatal period because of specific nutritional needs of preterm neonates which are not always covered by industrially produced parenteral nutrition. This review summarizes the risks of physicochemical instability associated with parenteral nutrition preparation in order to make recommendations to secure this mode of preparation.

Background Proton pump inhibitors (PPI) are commonly prescribed medications which are indicated in various different gastrointestinal (GI) diseases, including peptic ulcer disease, gastroesophageal reflux disorder and upper GI bleeding. There is some evidence to suggest that PPI use in cirrhosis may predispose to the development of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP), albeit with some controversy. Aims We aim to conduct a retrospective epidemiological analysis of the association between PPI use in hospitalized patients with cirrhosis, and prevalence of HE and SBP. Methods This was a retrospective cohort study of 600 adult patients (mean age 61.4 (SD=12.2)) admitted the Ottawa Hospital between January 1, 2011 and December 31, 2015 with cirrhosis. A chart review was conducted and relevant information extracted. Results Average MELD-Na on admission was 16.2 (sd=6.7). 14.8% of patients had a history of HE, 5.0% SBP, 7.8% with history of hepatocellular carcinoma and 1.0% with history of hepatorenal syndrome. 28.5% of patients had a history of varices, of which 11.0% had previous variceal bleeding. 69.3% of patients were on a PPI during their hospitalization. Not surprisingly, patients admitted with variceal bleeding were more likely to be exposed to PPI in hospital (97.2% vs 63.2%, p Conclusions We did not observe a significant difference in HE and SBP among this cohort of cirrhotic patients by in-hospital PPI use. We did however note significantly higher PPI use in patients with previous diagnosis of cirrhosis as compared to those who were newly diagnosed, as well as those whose admissions were related to bleeding. Patients with ascites had lower prevalence of PPI use. Prescribing patterns for PPIs in patients with cirrhosis warrant further attention, including clinical utility and longer-term risks and benefits of this therapy. Funding Agencies None

The Oxygen and Capacity-Limited Thermal Tolerance (OCLTT) hypothesis proposes that the thermal tolerance of an animal is shaped by its capacity to deliver oxygen in relation to oxygen demand. Studies testing this hypothesis have largely focused on measuring short-term performance responses in animals under acute exposure to critical thermal maximums. The OCLTT hypothesis, however, emphasises the importance of sustained animal performance over acute tolerance. The present study tested the effect of chronic hypoxia and hyperoxia during development on medium to long-term performance indicators at temperatures spanning the optimal temperature for growth in the speckled cockroach, Nauphoeta cinerea. In contrast to the predictions of the OCLTT hypothesis, development under hypoxia did not significantly reduce growth rate or running performance, and development under hyperoxia did not significantly increase growth rate or running performance. The effect of developmental temperature and oxygen on tracheal morphology and metabolic rate were also not consistent with OCLTT predictions, suggesting that oxygen delivery capacity is not the primary driver shaping thermal tolerance in this species. Collectively, these findings suggest that the OCLTT hypothesis does not explain moderate-to-long-term thermal performance in Nauphoeta cinerea, which raises further questions about the generality of the hypothesis.

In this study, for the first time, we examined some of the physico-chemical properties of the cell surface of Akkermansia muciniphila DSM 22959, comparing it with those of Lactobacillus rhamnosus GG—one of the most extensively studied probiotic microorganisms. In particular, hydrophobicity, auto-aggregation, co-aggregation, and biofilm formation were investigated. In addition, antibiotic susceptibility, co-culture, and antimicrobial activity of the two strains were compared. Hydrophobicity was evaluated using xylene and toluene, showing that A. muciniphila DSM 22959 possessed moderate hydrophobicity. A. muciniphila showed a faster and higher auto-aggregation ability than Lb. rhamnosus GG, but a lower aptitude in biofilm formation. In the co-aggregation test, the best performance was obtained by Lb. rhamnosus GG. Regarding the susceptibility to antibiotics, the differences between the two strains were remarkable, with A. muciniphila DSM 22959 showing resistance to half of the antibiotic tested. Interesting results were also obtained with regard to the stimulating effect of Lb. rhamnosus GG on the growth of A. muciniphila when co-cultured.

The oxygen and capacity-limited thermal tolerance (OCLTT) hypothesis proposes that the thermal tolerance of an animal is shaped by its capacity to deliver oxygen in relation to oxygen demand. Studies testing this hypothesis have largely focused on measuring short-term performance responses in animals under acute exposure to critical thermal maximums. The OCLTT hypothesis, however, emphasises the importance of sustained animal performance over acute tolerance. The present study tested the effect of chronic hypoxia and hyperoxia during development on moderate to long-term performance indicators at temperatures spanning the optimal temperature for growth in the speckled cockroach

Individualized parenteral nutrition is frequently used in neonatal period because of specific nutritional needs of preterm neonates which are not always covered by industrially produced parenteral nutrition. This review summarizes the risks of physicochemical instability associated with parenteral nutrition preparation in order to make recommendations to secure this mode of preparation.

The standardisation of packaging and containers for product handling has potential benefits from transportation, material handling and environmental perspectives. Likewise, standardised modular containers play an important role in the Physical Internet (PI). To support implementation of standard modular containers, we introduce a mathematical model to select a requisite number of modular containers to pack a set of products to maximise space utilisation. A decomposition-based solution methodology is developed and presented. Computational results from industry-based problem instances indicate that using standardised modular containers results in increased space utilisation at the unit load level. This finding substantiates the use of modular containers in moving toward the PI.

The incidence of arthroscopic rotator cuff repair (RCR) continues to rise. Given the changing healthcare climate, it is becoming increasingly important to critically evaluate current practice and attempt to make modifications that decrease costs without compromising patient outcomes. We conducted a study of the costs associated with arthroscopic anchorless (transosseous [TO]) RCR and those associated with the more commonly performed anchor-based TO-equivalent (TOE) method to determine whether there are any cost savings with the TO-RCR method. Twenty-one consecutive patients who underwent arthroscopic TO-RCR were prospectively enrolled in the study and matched on tear size and concomitant procedures with patients who underwent arthroscopic TOE-RCR. The groups' implant costs and operative times were obtained and compared. Outcome measures, including scores on the VAS (visual analog scale) for pain, the SANE (Single Assessment Numeric Evaluation), and the SST (Simple Shoulder Test), recorded at 3, 6, and12 months after surgery, were compared between the TO and TOE groups. Mean implant cost was $946.91 less for the TO group than the TOE group-a significant difference. Mean operative time was not significantly different between the TO and TOE groups. There was significant improvement on all outcomes measures (VAS, SANE, SST) at12 months, and this improvement was not significantly different between the groups. Arthroscopic TO-RCR provides significant cost savings over TOE-RCR with no significant difference in operative time or short-term outcomes.

OBJECTIVE To review and critically assess trends observed regarding the levels of evidence in published articles in orthopaedic traumatology literature. DATA SOURCES The Journal of Orthopaedic Trauma, Journal of Bone and Joint Surgery-American, and Clinical Orthopaedics and Related Research. STUDY SELECTION All articles from the years 1998, 2003, 2008, and 2013 in The Journal of Orthopaedic Trauma (JOT) and orthopaedic trauma-related articles from The Journal of Bone and Joint Surgery-American (JBJS-A) and Clinical Orthopaedics and Related Research (CORR) were analyzed. Articles were categorized by type and ranked for level of evidence according to guidelines from the Centre for Evidence-Based Medicine. DATA EXTRACTION Study type and standardized level of evidence were determined for each article. Articles were subcategorized as high-level evidence (I, II), moderate-level evidence (III), and low-level evidence (IV, V). DATA SYNTHESIS During the study period, Journal of Bone and Joint Surgery-American reduced its low-level studies from 80% to 40% (P = 0.00015), Clinical Orthopaedics and Related Research decreased its low-level studies from 70% to 27%, and Journal of Orthopaedic Trauma decreased its low-level studies from 78% to 45%. Level IV and V therapeutic, prognostic, and diagnostic studies demonstrated significant decreases during the study period (P = 0.0046, P < 0.0001, P = 0.026). The percentage of high-level studies increased from 13% to 19%; however, this was not significant (P = 0.42). There was a trend showing an increase in level I and II studies for therapeutic, prognostic, and diagnostic studies (P = 0.06). CONCLUSIONS There has been a statistically significant decrease in lower level of evidence studies published in the orthopaedic traumatology literature over the past 15 years.

Health care expenditures are rising in the United States. Recent policy changes are attempting to reduce spending through the development of value-based payment systems that rely heavily on cost transparency. This study was conducted to investigate whether cost disclosure influences surgeons to reduce operating room expenditures. Beginning in 2012, surgeon scorecards were distributed at a regional health care system. The scorecard reported the actual direct supply cost per case for a specific procedure and compared each surgeon's data with those of other surgeons in the same subspecialty. Rotator cuff repair was chosen for analysis. Actual direct supply cost per case was calculated quarterly and collected over a 2-year period. Surgeons were given a questionnaire to determine their interest in the scorecard. Actual direct supply cost per rotator cuff repair procedure decreased by $269 during the study period. A strong correlation ( R 2 =0.77) between introduction of the scorecards and cost containment was observed. During the study period, a total of $39,831 was saved. Of the surgeons who were queried, 89% were interested in the scorecard and 56% altered their practice as a result. Disclosure of surgical costs may be an effective way to control operating room spending. The findings suggest that providing physicians with knowledge about their surgical charges can alter per-case expenditures. [ Orthopedics. 2017; 40(2):e269–e274.]

The synthesis, isolation, purification (routine silica gel chromatography), and spectroscopic characterization of high-energy endo stereogenic-at-Ru complex isomers, generated by ring-opening/cross-metathesis (ROCM) reaction of the corresponding exo carbenes, are disclosed. We provide experimental evidence showing that an endo isomer can undergo thermal or Brønsted acid-catalyzed polytopal rearrangement, causing conversion to the energetically favored exo carbene.

Glass fiber-reinforced polymer (GFRP) bridge decks possess inherently high strength-to-weight ratios, but relatively low effective elastic moduli. As a result, serviceability issues govern GFRP bridge deck design. Therefore, the objective of this study was to increase the stiffness of a commercial GFRP honeycomb sandwich panel through the inclusion of steel within the cross section. GFRP-steel hybrid parametric studies were conducted to evaluate improvements on the GFRP honeycomb deck panel stiffness. Possible configurations included the embedment of steel plates within the face sheets and the placement of steel tubes within the core. Core stiffness analyses were also performed, leading to the development of the steel hexagonal honeycomb core concept. An experimental study, including large-scale beam tests, was conducted. The large-scale tests were performed to assess the equivalent flexural and shear stiffness, comparing the hybrid steel core concept and the current GFRP core design. From the large-scale beam test results, an overall stiffness increase was observed.

In the early 1970s Richard G. Horn established a methodology for analyzing the earnings of a life insurance company that reflected, at that time, the types of products underwritten and the accounting principles that were in effect. This methodology became to be known as a “sources of earnings analysis.” With the exception of term life insurance, most life insurance and annuity products underwritten today have significant equity risk. Furthermore, fair value accounting principles are replacing historical-based accounting principles. Finally, life insurance companies have sophisticated risk management policies and procedures to manage risk. The purpose of this paper is to extend Horn’s “sources of earnings analysis” to reflect the evolution in product design, accounting standards, and risk management practices. In particular, under fair value accounting principles, the capital account becomes the primary focus of attention. Accordingly, this paper develops a methodology to perform an “analysis of t...

Glass fiber-reinforced polymer (GFRP) materials possess inherently high strength-to-weight ratios, but their effective elastic moduli are low relative to civil engineering (CE) construction materials. While elastic modulus may be comparable to that of some CE materials, the lower shear modulus adversely affects stiffness. As a result, serviceability issues are what govern GFRP deck design in the CE bridge industry. An innovative solution to increase the stiffness of a commercial GFRP reinforced-sinusoidal honeycomb sandwich panel was proposed; this solution would completely replace the GFRP honeycomb core with a hexagonal honeycomb core constructed from commercial steel roof decking. The purpose of this study was to perform small-scale tests to characterize the steel hexagonal honeycomb core equivalent elastic moduli in an effort to simplify the modeling of the core. The steel core equivalent moduli experimental results were compared with theoretical hexagonal honeycomb elastic modulus equations from the literature, demonstrating the applicability of the theoretical equations to the steel honeycomb core. Core equivalent elastic modulus equations were then proposed to model and characterize the steel hexagonal honeycomb as applicable to sandwich panel design. The equivalent honeycomb core will enable an efficient sandwich panel stiffness design technique, both for structural analysis methods (i.e., hand calculations) and finite-element analysis procedures.

BAE Systems has developed a high power, high yield 70nm 6" 2-mil PHEMT MMIC process for frequencies up to 100GHz. Utilizing T -gate technology and 2-mil substrates, we have created a millimeter wave technology that produces excellent performance from Ka -band through W -bands. The device DC and RF characteristics have excellent uniformity across the wafer. In this paper, we report the 70nm device fabrication on 6-inch wafers and compare the DC and RF characteristics with its mature 0.1µm counterpart.

BACKGROUND: Preterm birth (PTB) is hypothesized to be an inflammatory response disease. However, no single factor alone is likely to explain PTB risk. It is more probable that coordinated networks of cytokines affect risk. METHODS: Therefore, we examined the relationships between amniotic fluid (AF) cytokines/chemokines and related biomarkers in PTB and normal term deliveries in African Americans and Caucasians. Data were obtained from African American (41 preterm labor and 91 term labor) and Caucasian (105 preterm labor and 100 term labor) pregnant mothers. Pro-inflammatory cytokines and related molecules interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor- (TNF)-α, TNF soluble receptors (sTNFR1 and sTNFR2), and anti-inflammatory cytokine IL-10 that were all previously associated with PTB were studied. Correlations between biomarkers were calculated; differences of correlation coefficients between AF from African American and Caucasian samples in preterm labor and term labor were measured. RESULTS: Multiple differences were observed between African American and Caucasian preterm and term birth groups. In term birth the strongest differences were between pro- and anti-inflammatory correlations, whereas in PTB differences were equally distributed between pro-inflammatory/anti-inflammatory and pro-inflammatory/pro-inflammatory correlations. Three correlation patterns differed significantly between AF from PTB African Americans with and without microbial invasion of the intra-amniotic cavity (MIAC); no differences were observed in Caucasians with MIAC. CONCLUSION: Correlation analyses of cytokine measurements suggest coordinated interplay during pregnancy; significant differences exist between African Americans and Caucasians. Such analyses can serve as a means of understanding risk factors in these populations.

Large titanium and aluminum sheet parts can now be formed into very complex assemblies by the process of superplastic forming. This has resulted in the need for major work to develop new alloys, new design methods and new manufacturing routes to ensure the production of high quality tooling. SPF tooling represents a significant part of the total cost of producing the super-plastically formed part. Careful selection of the material and its manufacturing route is essential in order to obtain the “right quality at the least cost” commensurate with the conditions of use. For many years the optimization of the alloy composition, the melting and casting foundry techniques and the design of the tools was done in a semi-empirical way, being largely based on practical experience. This method meant that the development was slow and unwieldy, and therefore, not compatible with the rapidly changing constraints of the SPF industry today. The fact that extremely powerful modelling programmes such as ThermoCalc and DICTRA are available for the design of new alloys, or Thercast for the optimization of the foundry melting and processing, makes it possible to introduce innovative techniques faster and with more immediate certitude as to their success. Thus, the casting process has become the most competitive and appropriate method of manufacture of the high performance tools in use today. This paper will discuss how these current technologies have been developed, and coupled with the experiences in the foundry, have assisted in the production of new materials, that optimize the tooling required in SPF operations.

Coverage of high school football by orthopedic sports medicine specialists is considered standard of care in many localities. Determining the economic viability of this endeavor has never been investigated. The primary purpose of the present investigation was to perform an economic analysis of local high school sports coverage by an orthopedic sports medicine practice.From January 2010 to June 2012, a prospective injury report database was used to collect sports injuries from five high school athletic programs covered by a single, private orthopedic sports medicine practice. Patients referred for orthopedic care were then tracked to determine expected cost of care (potential revenue). Evaluation and management codes and current procedure terminology codes were obtained to determine the value of physician visits and surgical care rendered. Overhead costs were calculated based on historical rates within our practice and incorporated to determine estimated profit.19,165 athletic trainer contacts with athletes playing all sports, including both those 'on-field' and in the training room, resulted in 473 (2.5%) physician referrals. The covering orthopedic practice handled 89 (27.9%) of the orthopedic referrals. Of orthopedic physician referrals, 26 (5.4%) required orthopedic surgical treatment. The covering team practice handled 17/26 (65%) surgical cases. The total revenue collected by the covering team practice was $26,226.14. The overhead cost of treatment was $9441.41. Overall estimated profit of orthopedic visits and treatment during this period for the covering practice was $16,784.73.The covering team practice handled 28% of the orthopedic referrals, 65% of the surgical cases and captured 59% of the potential profit. An increase in physician referrals could increase the benefit for orthopedic surgeons.

It is standard practice in high school athletic programs for certified athletic trainers to evaluate and treat injured student athletes. In some cases, a trainer refers an athlete to a physician for definitive medical management. This study was conducted to determine the rate of agreement between athletic trainers and physicians regarding assessment of injuries in student athletes. All high school athletes who were injured between 2010 and 2012 at 5 regional high schools were included in a research database. All patients who were referred for physician evaluation and treatment were identified and included in this analysis. A total of 286 incidents met the inclusion criteria. A total of 263 (92%) of the athletic trainer assessments and physician diagnoses were in agreement. In the 23 cases of disagreement, fractures and sprains were the most common injuries. Kappa analysis showed the highest interrater agreement in injuries classified as dislocations and concussions and the lowest interrater agreement in meniscal/labral injuries and fractures. In the absence of a confirmed diagnosis, agreement among health care providers can be used to infer accuracy. According to this principle, as agreement between athletic trainers and physicians improves, there is a greater likelihood of arriving at the correct assessment and treatment plan. Athletic trainers are highly skilled professionals who are well trained in the evaluation of athletic injuries. The current study showed that additional training in identifying fractures may be beneficial to athletic trainers and the athletes they treat. [ Orthopedics. 2016; 39(5):e944–e949.]

Chemotherapy is an essential component of therapy for infants and children with hepatoblastoma. Vincristine has been a mainstay of chemotherapeutic regimens used by North American cooperative groups, based on indirect evidence of benefit and an assumption of minimal added toxicity. European cooperative group trials have reported comparable survival rates using regimens that omit vincristine. Further examination of the risk and benefit profile of vincristine relevant to hepatoblastoma clinical care paradigms is thus warranted. We evaluated the incidence of vincristine-related sensorimotor peripheral, autonomic, and cranial nerve neurological morbidities in 45 consecutive hepatoblastoma patients treated at our institution. Data suggest an increased risk of vincristine-associated neuropathic grade 2 and 3 events (neuropathic pain and gross motor impairment) in children ages 24 months old or younger, and particularly in children born prematurely. Formal prospective investigation of the relative risks and benefits of vincristine in hepatoblastoma treatment is warranted to assess the value of continued use of vincristine in this patient population.

Problem The prematurity rate is higher in African-Americans (AA) compared with Caucasians (C). As spontaneous preterm labor has been hypothesized to be a host inflammatory response disease racial differences in human placental membrane inflammatory cytokine and prostaglandin pathway gene expression patterns between AA and C were examined in this report. Method of study Placental membranes (amniochorion) collected from AA and C women from cesareans at term were maintained in an organ explant system and stimulated with endotoxin (lipopolysaccharide, LPS). Microarray analysis and enzyme-linked immunosorbent assay was performed on mRNAs and culture media from AA- and C-derived membranes to document any differences in mRNA expression and protein production of IL-1, IL-6, IL-8, IL-10 and expression of cyclooxygenase 1 (COX-1), COX-2 and 15-hydroxyprostaglandin dehydrogenase (PGDH). Results Increased mRNA expression of IL-1, IL-8 and COX-2 in AA and IL-6, IL-10, COX-1 and PGDH in C were documented after LPS stimulation. Concentration of IL-1 was significantly higher in media derived from AA whereas IL-6 and IL-10 concentrations were higher in C with no differences observed in IL-8 after LPS stimulation compared with respective unstimulated controls. Conclusion These data document ethnic diversity in placental membrane immune response.

Objective. The objectives of this study were to document the expression of IL-19 and IL-20, localize their expression in human fetal membranes and to examine their influence on the production of other inflammatory cytokines (IL-1, IL-6, IL-8, and TNF-alpha) from placental membranes.Methods. Human fetal membranes collected at term from normal pregnancies were stimulated with either recombinant human IL-19, IL-20, bacterial endotoxin (LPS) alone or the cytokine + LPS. The expression of IL-19 and IL-20 was studied by reverse transcriptase polymerase chain reaction (RT-PCR) and localized using immunohistochemistry. Concentrations of IL-1, IL-6, IL-8, and TNF-alpha were measured with multiplex sandwich immunoassay using microsphere technology.Results. RT-PCR documented IL-19 and IL-20 gene expression in fetal membranes. Immunohistochemistry localized both peptides to amnion and chorion layers. LPS stimulated the production of all four cytokines (IL-1, IL-6, IL-8, and TNF-alpha) from fetal membranes compared to unstimulated controls. No change in IL-1 and IL-8 concentration was seen after IL-19 or IL-20 stimulation, whereas IL-6 concentration was three- and two-fold higher after IL-19 and IL-20 treatment, respectively. TNF levels were unchanged after IL-19 and IL-20 treatment; however, TNF levels were significantly decreased in membranes treated with IL-19 or IL-20 + LPS compared to LPS alone.Conclusion. Fetal membranes are a source of IL-19 and IL-20. These cytokines act as an inhibitory agent to LPS-induced TNF production whereas they stimulate IL-6 production and have no effect on IL-1 and IL-8 production from human fetal membranes. The effect of IL-19 and IL-20 in pregnancy will be dependent on their concentrations and other environmental factors such as infection.