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After surgery for a broken ankle, patients are usually instructed to avoid walking for 6 weeks (delayed weight-bearing). Walking 2 weeks after surgery (early weight-bearing) might be a safe and preferable rehabilitation strategy. This study aimed to determine the clinical and cost effectiveness of an early weight-bearing strategy compared with a delayed weight-bearing strategy.

In this article, I will elucidate the Indian government’s two primary discourses concerning yoga since 2014 as right-wing Hindu Nationalist Prime Minister Narendra Modi and his Hindu Nationalist political party, the Bharatiya Janata Party (BJP), have interacted with both international and domestic audiences. These discourses can be broadly grouped into two categories, or what I refer to as Modi and the BJP’s “double discourse”: (1) Yoga as a global soft powersolution to counter the Global North’s climate change privilege on the international stage and (2) Yoga as biopowerfor the advancement of India’s depressed economy on the domestic front. Relying on yoga’s polyvalent character, Modi and the BJP are able to frame yoga in these two particular ways—which together signal their commitment to neoliberal economic ideology—by drawing from historical and contemporaneous precedents which I also outline in the article. I conclude with a brief visit to the preparations for the BJP’s 2019 International Day of Yoga, where this double discourse becomes most evident in the two divergent themes announced for the event.

As the volume and complexity of patients requiring intensive care grows, so do the barriers and challenges to the delivery of that care. This article summarizes these challenges, outlines strategies used to overcome them, and presents new developments and concepts within the care of the ICU patient.

Abstract:Hart Crane's lyrics abound with transient figures who often doubt their intelligibility or viability as persons, and his letters reflect a significant anxiety about his own ability to communicate the problems he experienced in being and remaining intelligible to others. Against that background, this article offers a reading of Crane's transient figures as linguistic performances of such doubtful and tenuous existences. In this, the article puts Crane in dialogue with one of his most admired and mimicked contemporaries, Charlie Chaplin, as well as with theories of transient sociability from language philosophy, urban sociology, and modernist studies.

Hart Crane’s lyrics abound with transient figures who often doubt their intelligibility or viability as persons, and his letters reflect a significant anxiety about his own ability to communicate the problems he experienced in being and remaining intelligible to others. Against that background, this article offers a reading of Crane’s transient figures as linguistic performances of such doubtful and tenuous existences. In this, the article puts Crane in dialogue with one of his most admired and mimicked contemporaries, Charlie Chaplin, as well as with theories of transient sociability from language philosophy, urban sociology, and modernist studies.

Congenital midline cervical cleft (CMCC) is a rare congenital difference. Accurate diagnosis is important to ensure appropriate treatment. CMCC results in both functional and esthetic concerns addressed by surgical management. While the majority of reported CMCC cases have been treated with a z-plasty, the best method of repair has been debated in the literature. The authors present a case of CMCC and review of the literature.

The track switch is one of the key assets in any railway network. It is essential to allow trains to change route; however, when it fails, significant delays are almost inevitable. A relatively common fault is ‘loss of detection’, which can happen when there is a gradual track movement and the switch machines (actuators) no longer close the gap between the switch rail and stock rail to within safe tolerance levels. Currently, such misalignment is mitigated by a preventative programme of inspection and manual re-adjustment. In contrast to many other industries, the actuators are exclusively operated in open loop, with sensors (often limit switches) mainly being used for detection. Hence, an opportunity exists to investigate the closed loop control concepts for improving the operation of the switch. This paper proposes two advances: first, a novel approach is taken for modelling the dynamic performance of track switch actuators and the moving permanent-way components of the switch. The model is validated against real data from an operational switch. Secondly, the resulting dynamic model is then used to examine the implementation of closed loop feedback control as an integral part of track switch actuation. The proposed controller is found to perform well and offers the potential of ‘self-adjustment’, i.e. re-adjusting itself to close any gap (within a predefined range) between the stock and switch rails, thereby completing the switching operation.

Yoga in Britain: Stretching Spirituality and Educating Yogis, by Suzanne Newcombe. Sheffield: Equinox, 2019. xiv + 309 pp., £75.00 / $100.00 (hb), £24.95 / $36.00 (pb). ISBN 978-1-78179-659-7 (hb), 978-1-78179-661-0 (pb).

Targeted modification of electronic structure is an important step in the optimization of metal–organic frameworks (MOFs) for photovoltaic, sensing, and photocatalytic applications. The key parameters to be controlled include the band gap, the absolute energy position of band edges, the excited state charge separation, and degree of hybridization between metal and ligand sites. Partial metal replacement, or metal doping, within secondary building units is a promising, yet relatively unexplored route to modulate these properties in MOFs. Therefore, in the present study, a general method for selecting metal dopant is worked out in theory and validated by experiment, retaining MIL-125 and UiO-66 as the model systems. Metal mixing enables targeted optimization of key electronic structure parameters. This method is applicable to any MOF architecture and can serve as a roadmap for future synthesis of MOFs with predefined properties.

Melatonin is involved in regulation of a variety of physiologic functions, including circadian rhythm, reproduction, mood, and immune function. Exogenous melatonin has demonstrated many clinical effects. Numerous clinical studies have documented improved sleep quality following administration of exogenous melatonin. Recent studies also demonstrate the analgesic, anxiolytic, antiinflammatory, and antioxidative effects of melatonin. This article reviews the principal properties of melatonin and how these could find clinical applications in care of the critically ill patients.

Background: Patients with sickle cell disease (SCD) suffer a significant disease burden that affects their psychosocial well-being. Digital cognitive-behavioral therapy (CBT) has been utilized in other patient populations and shown to have clinical benefits. Although evidence-based, non-pharmacological interventions for pain management are widely used in other populations, this is not well studied in SCD. There are currently no large-scale, adequately powered clinical trials that evaluate the effectiveness and dissemination potential of digital behavioral pain management interventions for adults with SCD.

Introduction: Adults living with sickle cell disease (SCD) most frequently seek medical care due to pain. To determine the most efficacious treatment plan for patients presenting with pain, providers must first accurately assess and diagnose the pain. Unfortunately, the current approaches for assessing pain are inadequate. Combined with medical provider biases, patients can often have their pain symptoms misinterpreted, ignored, or blatantly dismissed. To address this issue, we partnered with stakeholders, human-centered designers, and software engineers to design a novel pain assessment tool, called Painimation. Painimation allows patients to communicate their pain quality, intensity, and location using abstract animations and a paintable body image. Painimation has been validated in a general population with chronic pain, but there is limited data validating this approach in SCD. Preliminary data on the use of Painimation by adults with SCD (N = 67) found that those who described their pain using the “throbbing” animation had less severe pain symptoms than those endorsing the “shooting” animation.

Background:Sedative agents used during cardiac surgery can influence the patient’s time to extubation, intensive care unit (ICU) and hospital length of stay, and incidence of delirium. Objective:This study evaluates the effects of the intraoperative and postoperative use of dexmedetomidine versus propofol infusions. Methods:This 19-month retrospective observational study at an academic medical center included 278 patients 18 years of age or older who underwent coronary artery bypass grafting (CABG), valve replacement surgery, or combined CABG plus valve surgery, who received either a dexmedetomidine or propofol infusion in addition to general anesthesia intraoperatively. The primary outcome was time to extubation. The secondary outcomes were ICU and hospital length of stay and incidence of delirium. Results:Use of dexmedetomidine (n = 69) as an intraoperative and postoperative sedative as opposed to propofol (n = 209) was significantly associated with increased likelihood of extubation (ie, shorter time to extubation; hazard ratio = 1.63, 95% CI = 1.21-2.19, P= 0.001). There was no significant association between use of dexmedetomidine and ICU discharge (P= 0.99), hospital discharge (P= 0.52), and incidence of delirium (P= 0.27) after adjusting for other covariates. Conclusion and Relevance:Dexmedetomidine increased the likelihood of extubation when compared with propofol, with no increase in ICU or hospital length of stay or incidence of delirium. Our study is unique in that there was no crossover between patients who received dexmedetomidine and propofol infusions intraoperatively and postoperatively Dexmedetomidine-based regimens could serve as a suitable alternative to propofol-based regimens for fast-track extubation.

Kersten [Vision Res.27, 1029 (1987)] reported that absolute efficiency for the detection of static, one-dimensional bandpass noise was high and approximately constant for stimulus bandwidths ranging from 1 to 6 octaves. This result implies that human observers integrated information efficiently across a wide range of spatial frequency. One interpretation of this result—and similar results obtained with auditory stimuli [J. Acoust. Soc. Am.32, 121 (1960)]—is that human observers, like ideal observers, can detect stimuli using an internal filter that has an adjustable bandwidth. The current experiments replicate Kersten's findings, extend them to the case where observers are uncertain about stimulus bandwidth, and use the classification image technique to estimate the filter used to detect noise stimuli that differ in bandwidth. Our results suggest that observers do not adjust channel bandwidth to match the stimulus and that detection thresholds are consistent with the predictions of a multiple-channel model.

This article provides an atlas to the senior author’s use of the Anatomical Subunit approach to primary cheilorhinoplasty as described by Fisher and Tse, including description of the nasal base reconstruction. Additional figures assist in understanding the identification of landmarks and incision design with the first year resident in mind.

Haywood: NHLBI: Research Funding. Lanzkron:NHLBI: Research Funding.

Introduction: