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ABSTRACTUnderstanding the scour process around bridge piers and investigating approaches to reduce these phenomena is an important issue for engineers. Side-by-side piers cause lower scour depth compared to a single pier with the same diameter. In this study, the application of downstream bed sill and continuous footing to control the scour depth around single piers and two side-by-side piers is investigated experimentally. The results show that by using a continuous footing with a thickness equal to the pier diameter, the scour depth in front of the pier is reduced by 50% and 55% for single pier and side-by-side piers, respectively. Moreover, when the continuous footing thickness is doubled, no scour depth is observed in front of the pier. Additionally, incorporating a downstream bed sill adjusted to the pier results in a reduction of approximately 30% in scour depth in front of the piers.

We propose a novel unsupervised anomaly detection and diagnosis algorithm in power electronic networks. Since most anomaly detection and diagnosis algorithms in the literature are based on supervised methods that can hardly be generalized to broader scenarios, we propose unsupervised algorithms. Our algorithm extracts the Time-Frequency Domain (TFD) features from the three-phase currents and three-phase voltages of the point of coupling (PCC) nodes to detect anomalies and distinguish between different types of anomalies, such as cyber-attacks and physical faults. To detect anomalies through TFD features, we propose a novel Informative Leveraging for Anomaly Detection (ILAD) algorithm. The proposed unsupervised ILAD algorithm automatically extracts noise-reduced anomalous signals, resulting in more accurate anomaly detection results than other score-based methods. To assign anomaly types for anomaly diagnosis, we apply a novel Multivariate Functional Principal Component Analysis (MFPCA) clustering method. Unlike the deep learning methods, the MFPCA clustering method does not require labels for training and provides more accurate results than other deep embedding-based clustering approaches. Furthermore, it is even comparable to supervised algorithms in both offline and online experiments. To the best of our knowledge, the proposed unsupervised framework accomplishing anomaly detection and anomaly diagnosis tasks is the first of its kind in power electronic networks.

ABSTRACTIn this paper, a new compact dual-band bandpass filter (DB-BPF) is proposed using parallel coupled lines. The design method is based on introducing transmission zeros (TZs) in the frequency response of a single-wideband filter. In the proposed structure, three coupled lines and a multi-mode resonator are used to realize the wide bandpass filter. Meanwhile, two coupled lines that are connected at the end and loaded by an open-circuit stub are employed to make a new notch filter. The proposed DB-BPF is designed and fabricated on Rogers RO3210 substrate for Wireless Local Area Networks (WLANs) applications. The simulation results show good agreement with measurements. The measured results exhibit two passbands centered at 2.4 and 5.2 GHz, having an insertion loss of less than 0.1 dB and 0.9 dB, respectively. Low insertion loss, compact size, and high attenuation between two passbands are the main advantages of the proposed DB-BPF.

Real-time ultrasound imaging plays an important role in ultrasound-guided interventions. The 3-D imaging provides more spatial information compared to conventional 2-D frames by considering the volumes of data. One of the main bottlenecks of 3-D imaging is the long data acquisition time, which reduces practicality and can introduce artifacts from unwanted patient or sonographer motion. This article introduces the first shear wave absolute vibro-elastography (S-WAVE) method with real-time volumetric acquisition using a matrix array transducer. In S-WAVE, an external vibration source generates mechanical vibrations inside the tissue. The tissue motion is then estimated and used in solving a wave equation inverse problem to provide the tissue elasticity. A matrix array transducer is used with a Verasonics ultrasound machine and a frame rate of 2000 volumes/s to acquire 100 radio frequency (RF) volumes in 0.05 s. Using plane wave (PW) and compounded diverging wave (CDW) imaging methods, we estimate axial, lateral, and elevational displacements over 3-D volumes. The curl of the displacements is used with local frequency estimation to estimate elasticity in the acquired volumes. Ultrafast acquisition extends substantially the possible S-WAVE excitation frequency range, now up to 800 Hz, enabling new tissue modeling and characterization. The method was validated on three homogeneous liver fibrosis phantoms and on four different inclusions within a heterogeneous phantom. The homogeneous phantom results show less than 8% (PW) and 5% (CDW) difference between the manufacturer values and the corresponding estimated values over a frequency range of 80–800 Hz. The estimated elasticity values for the heterogeneous phantom at 400-Hz excitation frequency show the average errors of 9% (PW) and 6% (CDW) compared to the provided average values by magnetic resonance elastography (MRE). Furthermore, both imaging methods were able to detect the inclusions within the elasticity volumes. An ex vivo study on a bovine liver sample shows less than 11% (PW) and 9% (CDW) difference between the estimated elasticity ranges by the proposed method and the elasticity ranges provided by MRE and acoustic radiation force impulse (ARFI).

Background: Perioperative pain management is important for patient satisfaction while returning to homeostasis in the safest way possible. Studies show that patients don’t require as much opioids as once thought. The benefits of ERAS pathways extend beyond enhancement of patients’ perioperative experience, and include reducing opioid prescriptions in the face of the ongoing nationwide opioid crisis and evidence of prescription opioids as a contributor. Methods: We performed a retrospective cohort study of patients undergoing same day minimally invasive surgery (MIS) procedures for GI and hernia disease using a minimal-opioid ERAS protocol at two community hospitals between January 2020 and May 2022. We included elective laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) for acute appendicitis without perforation, and minimally invasive (laparoscopic and robotic) inguinal and ventral hernia repair or abdominal wall reconstruction (AWR). Primary outcome was postoperative opioid use. Results: A total of 509 patients were included, undergoing procedures of MIS hernia repair (52.5%), LC (43.6%), and LA (7.9%). Only 9.4% of patients received opioid prescriptions at discharge, with no difference between groups. Among the patients receiving a prescription at discharge, there was a significant difference in morphine milligram equivalents (MME) prescribed (25.0 ± 0.0 in the LA group, 65.0 ± 41.4 in the LC group, 100.6 ± 46.2 in the MIS hernia/AWR group; P= 0.015). Nine percent of patients called with pain management concerns postoperatively. ASA score ≥ 3 was associated with increased odds for postoperative opioid prescription (OR 2.084; P= 0.014). Conclusions: We demonstrate that an opioid-sparing ERAS program effectively manages pain for patients undergoing multiple outpatient MIS GI/hernia procedures, and suggests generalizability across a diverse range of operations. Therefore, the use of ERAS may safely and effectively expand beyond inpatient MIS and open surgeries that target reduced length of stay to also minimize opioids for outpatient procedures.

ABSTRACTIn this paper, a radial basis function neural network (RBF-NN) automatic sonar target recognition system is proposed. For the RBF-NN training phase, a whale optimisation algorithm (WOA) developed with a fuzzy system has been used (which is called FWOA). The reason for using the fuzzy system is the lack of correct identification of the boundary between the two stages of exploration and exploitation. Thus, the tuning of the effective parameters of the WOA is left to the fuzzy system of the Mamdani type. RBF-NN was trained by chimp optimisation algorithm (ChOA), genetic algorithm (GA), Evolution Strategy (ES), league championship algorithm (LCA), grey wolf algorithms (GWO), gravitational search algorithm (GSA), and WOA to compare the proposed algorithm. The measured criteria are convergence speed, ability to avoid local optimisation, and classification rate. The simulation results showed that FWOA with 97.49% classification accuracy rate in sonar data performed better than the other seven benchmark algorithms.

Autism Spectrum Disorder (ASD) diagnosis remains behavior-based and the median age of diagnosis is ~52 months, nearly 5 years after its first-trimester origin. Accurate and clinically-translatable early-age diagnostics do not exist due to ASD genetic and clinical heterogeneity. Here we collected clinical, diagnostic, and leukocyte RNA data from 240 ASD and typically developing (TD) toddlers (175 toddlers for training and 65 for test). To identify gene expression ASD diagnostic classifiers, we developed 42,840 models composed of 3570 gene expression feature selection sets and 12 classification methods. We found that 742 models had AUC-ROC ≥ 0.8 on both Training and Test sets. Weighted Bayesian model averaging of these 742 models yielded an ensemble classifier model with accurate performance in Training and Test gene expression datasets with ASD diagnostic classification AUC-ROC scores of 85–89% and AUC-PR scores of 84–92%. ASD toddlers with ensemble scores above and below the overall ASD ensemble mean of 0.723 (on a scale of 0 to 1) had similar diagnostic and psychometric scores, but those below this ASD ensemble mean had more prenatal risk events than TD toddlers. Ensemble model feature genes were involved in cell cycle, inflammation/immune response, transcriptional gene regulation, cytokine response, and PI3K-AKT, RAS and Wnt signaling pathways. We additionally collected targeted DNA sequencing smMIPs data on a subset of ASD risk genes from 217 of the 240 ASD and TD toddlers. This DNA sequencing found about the same percentage of SFARI Level 1 and 2 ASD risk gene mutations in TD (12 of 105) as in ASD (13 of 112) toddlers, and classification based only on the presence of mutation in these risk genes performed at a chance level of 49%. By contrast, the leukocyte ensemble gene expression classifier correctly diagnostically classified 88% of TD and ASD toddlers with ASD risk gene mutations. Our ensemble ASD gene expression classifier is diagnostically predictive and replicable across different toddler ages, races, and ethnicities; out-performs a risk gene mutation classifier; and has potential for clinical translation.

A dynamic inductive power transfer (IPT) system is a safe and convenient solution for providing power to electric vehicles (EVs) while they are driving along a roadway. This technology can help reduce the size and cost of the bulky EV batteries without limiting the EV's travelling range. In recent years, practical aspects of dynamic IPT systems have been investigated to advance various IPT technologies from laboratories into roadways. This article suggests an IPT roadway layout, focusing on a modular IPT system configuration with an integrated semiloosely coupled planar transformer inside the in-road coupler to mitigate the installation and maintenance concerns of IPT roadways. The proposed configuration keeps the current in the couplers constant and load-independent while providing galvanic isolation between the coupler and the converter, and can be used as a replacement for the conventional LCL and transformer configuration. In order to reduce the number of components used in each module, each in-road coupler is connected to a common H-bridge through a single dc switch to enable individual couplers to be energized independently. Mathematical analysis and simulation results are provided, and validated using a scaled 7.7-kW prototype IPT system employing the proposed configuration.

Background: Despite many advances, patients with a poor ovarian response to stimulation are one of the most important and challenging factors of infertility. Chronological and ovarian ages are two effective factors responsible for poor response to assisted reproduction treatment. The purpose of this study was to determine the effect of age and AMH level on the in vitro fertilization (IVF) outcomes in participants with a reduced ovarian reserve. Methods: In this retrospective cross-sectional study, 210 participants with anti-Mullerian hormone (AMH) < 1.1 ng/ml were included. The effect of age and AMH on pregnancy outcomes including dominant follicle count, serum estradiol level on the day of trigger administration, number of metaphase II (MII) oocytes, number of embryos, biochemical pregnancy, clinical pregnancy, abortion and live birth rate were evaluated. Results: The number of dominant follicle (p< 0.001), MII oocyte (p< 0.001), grade A (p< 0.001) and B (p< 0.001) embryos, serum estradiol level (p< 0.001), gonadotropin level ( p< 0.001), AMH (p= 0.001), biochemical pregnancy (p= 0.007), clinical (p= 0.01) pregnancy, and live birth rate (p= 0.003) were higher in participants younger than 35 years old. In univariable logistic regression, the chance of retrieving more than 3 oocytes in individuals over 35 years old was 97.1% lower than in individuals younger than 35 years old (p< 0.001). Conclusion: It has been concluded that the higher clinical pregnancy and live birth rate in participants younger than 35 years can be due to the higher AMH level in this group. Under the same conditions of AMH and other variables, age can affect the number of retrieved oocytes.

ABSTRACTDistribution of lateral velocity and suspended sediment concentration in river bends is highly non-uniform. Predicting such velocity and sediment distributions is prerequisite for many applications, such as river bank protection, sediment transport, deposition pattern, pollutant transport and flood control. Due to secondary flow development, flow structure in river bends has three-dimensional feature. In this case, one-dimensional mathematical models are generally not suitable, so two- or three-dimensional mathematical models have to be used. In this paper, field measurement of lateral distributions of flow velocity and suspended sediment concentration was conducted in three bends at the Karun River in Iran (namely, Jangieh, Khabineh and Malheh), and the measured velocity data were used for calibrating the Spooner and Shiono model. Based on the lateral velocity distributions by this mathematical model, sediment transport capacities were computed using five commonly used empirical formulas of sediment transport. The results showed that in the three river bends, the sediment transports formula by Yang agrees well with the measured lateral sediment concentration. The Van Rijn formula also predicts the results with suitable accuracy. The other three formulas by Ackers-White, Engelund-Hansen, and Karim-Kennedy significantly over-predict the sediment concentration compared with the measured data.

ABSTRACTThe number of official translations of games in the videogame market of Iran is very scant. Additionally, the existing ones contain only dubbed or subtitled menus, dialogues and narrations, and they has left the rest of in-game texts untranslated. Therefore, the translation needs should be analysed, but study of the game platforms has been ignored. In view of this gap, the current study aimed to analyse Iranian videogame players’ needs of the translation of in-game texts. To this end, 5000 gamers’ comments about the translations of in-game texts (i.e. menus, game installer applications, system messages, dialogues, narrations, and game manuals) of eight strategy videogames were collected by adopting the participative role and interviewing the professional gamers. The data were then analysed using an inductive approach via Microsoft Word. The findings indicated that the gamers preferred to play games having translated menus, game installer applications, system messages and game manuals; however, they preferred untranslated dialogues and narrations of the games. The findings of the study have implications for professional translators working in the market of videogames.

Textile manufacturing is one of the major industries that discharge an enormous quantity of dyes over the printing and dyeing process. Accordingly, the increasing demand for efficient and inexpensive treatment has enabled the innovation of low-cost alternative adsorbents. In this study, agricultural biomass from the Moroccan Sahara (ABMS) was investigated as an ecofriendly and low-cost biosorbent of textile dye. The effect of independent variables affecting the process fixed-bed adsorption such as inlet textile dye concentration (40, 80, and 120 mg L–1), flow rate (2, 4, and 6 mL min–1) and bed height (5, 10, and 15 mm), were modeled and evaluated by response surface methodology based on the Box–Behnken design. The kinetic models, Thomas and Yoon and Nelson model were applied to experimental data to predict the breakthrough curves using linear regression and to determine the characteristic parameters of the packed bed column. The data were in good agreement for both models with R2> 0.95. The maximum Methylene blue dye removal capacity was found to be 30.15 mg g–1. These findings suggested that ABMS biosorbent without any activation in the column structure presents great potential in the removal of dyes from textile wastewater.

ABSTRACTCSIRO has extensive experience and track record in turning powders into products. Through the CSIRO Lab 22 and associations, the teams in CSIRO are tailoring metal powders to processes, repurposing waste for additive manufacturing (AM) processes and generating unique materials, products and processes for Australia. The laboratory also houses Australia’s own metal printer from Aurora Labs that can operate in both direct laser melting (DLM) and laser powder bed fusion (LPBF) modes. This paper discusses capability and case study examples, with some scientific detail, as we work to mainstream and industrialise AM.

Background: Morbidity and recurrence rates are higher in obese patients undergoing open abdominal wall reconstruction (AWR). Historically, body mass index (BMI) ≥ 40 has served as a relative contraindication to open AWR. The purpose of this study is to evaluate the impact of minimally invasive surgery (MIS) on outcomes after AWR for higher versus lower BMI patients. Methods: A retrospective review of a prospectively maintained database was conducted of all patients who underwent MIS AWR between September 2015 and April 2019 at our institution. Patients were subdivided into two groups based on their BMI: BMI ≤ 35 kg/m2and BMI > 35 kg/m2. Patient demographics and perioperative data were evaluated using univariate and multivariate analysis. Results: 461 patients were identified and divided into two groups: BMI ≤ 35 (n= 310) and BMI > 35 (n= 151). The two groups were similar in age (BMI ≤ 35: 56.3 ± 14.1 years vs. BMI > 35: 54.4 ± 11.9, p= .154). BMI > 35 group had more patients with ASA score of 3 (81% vs. 32%, p< .001) and comorbid conditions such as hypertension (70% vs. 45%, p< .001), diabetes mellitus (32% vs. 15%, p< .001), and history of recurrent abdominal wall hernia (34% vs. 23%, p= .008). BMI > 35 group underwent a robotic approach at higher rates (74% vs. 45%, p< .001). Patients who underwent a Rives–Stoppa repair from the higher BMI cohort also had a larger defect size (5.6 ± 2.4 cm vs. 6.7 ± 2.4 cm, p= .004). However, there were no differences in defect size in patients who underwent a transversus abdominus release (BMI ≤ 35: 9.7 ± 4.9 cm vs. BMI > 35: 11.1 ± 4.6 cm, p= .069). Both groups benefited similarly from a short length of stay, similar hospital charges, and lower postoperative complications. Conclusion: Initial findings of our data support the benefits of elective MIS approach to AWR for patients with higher BMI. These patients derive similar benefits, such as faster recovery with low recurrence rates, when compared to lower BMI patients, while avoiding preoperative hernia incarceration, postoperative wound complications, and hernia recurrences. Future follow-up is required to establish long-term perioperative and quality of life outcomes in this patient cohort.

Background: The hybrid approach to abdominal wall reconstruction (AWR) for abdominal wall hernias combines minimally invasive posterior component separation and retromuscular dissection with open fascial closure and mesh implantation. This combination may enhance patient outcomes and recovery compared to the open approach alone. The purpose of this study is to evaluate the operative outcomes of hybrid vs. open abdominal wall reconstruction. Methods: A retrospective review was conducted to compare patients who underwent open versus hybrid AWR between September 2015 and August of 2018 at Anne Arundel Medical Center. Patient demographics and perioperative data were collected and analyzed using univariate analysis. Results: Sixty-five patients were included in the final analysis: 10 in the hybrid and 55 in the open groups. Mean age was higher in the hybrid vs. open group (65.1 vs. 56.2 years, p< 0.05). The hybrid and open groups were statistically similar (p> 0.05) in gender distribution, mean BMI, and ASA score. Intraoperative comparison found hybrid patients parallel to open patients (p> 0.05) in mean operative time (294.5 vs. 267.5 min), defect size (14.4 vs. 13.6 cm), mesh area, and drain placement. The mean total hospital cost was lower in the hybrid group compared to the open group ($16,426 vs. $19,054, p= 0.43). The hybrid group had a shorter length of stay (5.3 vs. 3.6 days, p= 0.03) after surgery and was followed for a similar length of time (12.3 vs. 12.6 months, p= 0.91). The hybrid group showed a lower trend of seroma, hematoma, wound infection, ileus, and readmission rates after surgery. Conclusion: A review of patient outcomes after hybrid AWR highlights a trend towards shorter length of stay, lower hospital cost, and fewer complications without significant addition to operative time. Long-term studies on a larger number of patients are definitively needed to characterize the comprehensive benefits of this approach.

Graphic abstract:

ABSTRACTBackgroundHybrid vesicular systems (lipopolymersomes) are promising platforms for minimizing the liposomes and polymersomes disadvantages in terms of chemotherapeutic transportation. In this regard, lipopolymersome has been designed to integrate the advantage of both polymersomes and liposomes to enable better structural integrity of the bilayer after encapsulation of hydrophobic drugs while maintaining the soft nature of liposomes, superior serum stability, and high encapsulation efficiency of cargos in the bilayer segment.Research design and MethodsIn the present study, we reported preparation and characterization of five camptothecin (CPT)-loaded lipopolymersomal formulations composed of poly (ethylene glycol)–poly (lactic acid) (PEG-PLA) and dipalmitoylphosphatidylcholine (DPPC) at different molar ratios using film rehydration method. Afterward, the preferred formulation was tagged with AS1411 DNA aptamer in order to evaluate the therapeutic index using nucleolin-positive colon cancer cell lines (HT29 and C26).ResultsThe obtained data indicated that the prepared CPT-loaded lipopolymersome at a PEG-PLA: DPPC ratio of 75:25 exhibited superior stability and high loading capacity compared to other systems. Moreover, high cytotoxicity of the aptamer-targeted lipopolymersome and increased tumor accumulation were observed in comparison with non-targeted one.ConclusionsThe designed polymer-rich lipopolymersomal platform offers bright future for the development of potent nanomedicine against cancer.

Background: Gastroesophageal reflux disease (GERD) is a common chronic disorder of the gastrointestinal tract, affecting more than 50% of Americans. The development of GERD may be associated with ineffective esophageal motility (IEM). The impact of esophageal motility on outcomes post laparoscopic antireflux surgery (LARS), including quality of life (QOL), remains to be defined. The purpose of this study is to analyze and compare QOL outcomes following LARS among patients with and without ineffective esophageal motility (IEM). Methods: This is a single-institution, retrospective review of a prospectively maintained database of patients who underwent LARS, from January 2012 to July 2019, for treatment of GERD at our institution. Patients undergoing revisional surgery were excluded. Patients with normal peristalsis (non-IEM) were distinguished from those with IEM, defined using the Chicago classification, on manometric studies. Four validated QOL surveys were used to assess outcomes: Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Health-Related QOL (GERD-HRQL), Laryngopharyngeal Reflux Health-Related QOL (LPR-HRQL), and Swallowing Disorders (SWAL) survey. Results: 203 patients with complete manometric data were identified (75.4% female) and divided into two groups, IEM (n= 44) and non-IEM (n= 159). IEM and Non-IEM groups were parallel in age (58.1 ± 15.3 vs. 62.2 ± 12 years, p= 0.062), body mass index (27.4 ± 4.1 vs. 28.2 ± 4.9 kg/m2, p= 0.288), distribution of comorbid disease, sex, and ASA scores. The groups differed in manometry findings and Johnson–DeMeester score (IEM: 38.6 vs. Non-IEM: 24.0, p= 0.023). Patients in both groups underwent similar rates of Nissen fundoplication (IEM: 84.1% vs. Non-IEM: 93.7%, p= 0.061) with greater improvements in dysphagia (IEM: 27.4% vs. 44.2%) in Non-IEM group but comparable benefit in reflux reduction (IEM: 80.6% vs. 72.4%) in both groups at follow-up. There were no differences in postoperative outcomes. Satisfaction rates with LARS were similar between groups (IEM: 80% vs. non-IEM: 77.9%, p> 0.05). Conclusion: Patients with ineffective esophageal motility derive significant benefits in perioperative and QOL outcomes after LARS. Nevertheless, as anticipated, their baseline dysmotility may reduce the degree of improvement in dysphagia rates post-surgery compared to patients with normal motility. Furthermore, the presence of preoperative IEM should not be a contraindication for complete fundoplication. Key to optimal outcomes after LARS is careful patient selection based on objective perioperative data, including manometry evaluation, with the purpose of tailoring surgery to provide effective reflux control and improved esophageal clearance.

Lattice oxygen loss from transition metal oxide cathodes in Li-ion batteries (LiBs) is a key factor responsible in their gradual capacity decline over time. Understanding and mitigating this phenomenon is crucial for the development of next-generation LiBs. The effect of various parameters on lattice oxygen loss, such as cathode chemical composition, has been studied extensively. However, there is a lack of experimental investigation into the lattice oxygen stability across different crystallographic facets within the same cathode composition. Here, we employed in situ scanning electrochemical microscopy (SECM) to investigate oxygen evolution from preferentially faceted, electrodeposited LiCoO2cathodes. Samples predominantly exposing the (003) basal planes and the (101), (102), (110) fast Li-ion diffusing facets exhibited oxygen evolution at potentials exceeding 3.5 V vs Li+/Li. Finite element simulations helped quantify the flux of oxygen evolution on the first charge cycle to 33 ± 5 pmol cm−2s−1for the basal plane and 37 ± 9 pmol cm−2s−1for the faceted samples at potentials above 4 V based on single spot measurements. However, spatially resolved measurements showed that faceted samples exhibited significant heterogeneity in their oxygen evolution, reaching twofold values compared to the basal plane samples at potentials beyond 4.5 V.

Introduction: Gastroesophageal reflux disease (GERD) may manifest atypically as cough, hoarseness or difficulty breathing. However, it is difficult to diagnostically establish a cause-and-effect between atypical symptoms and GERD. In addition, the benefit of laparoscopic anti-reflux surgery (LARS) in patients with laryngopharyngeal manifestations of GERD are not well characterized. We report the largest series reported to date assessing operative and quality of life (QOL) outcomes after LARS in patients experiencing extraesophageal manifestations of GERD and discuss recommendations for this patient population. Methods: A retrospective review of patients with extraesophageal symptoms and pathologic reflux that underwent LARS between February 2012 and July 2019 was conducted. Inclusion criteria consisted of patients with atypical manifestations of GERD as defined by preoperative survey in addition to physiological diagnosis of pathological reflux. Patient QOL outcomes was analyzed using four validated instruments: the Reflux Symptom Index (RSI), Laryngopharyngeal Reflux QOL, Swallowing QOL (SWAL), and Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQOL) surveys. Results: 420 patients (24% male, 76% female) with a mean age of 61.7 ± 13.0 years and BMI of 28.6 ± 5.0 kg/m2were included in this study. Thirty-day wound (0.2%) and non-wound (6.74%) related complication rates were recorded in addition to thirty-day readmission rate (2.6%). Patients reported significant improvements in laryngopharyngeal symptoms at mean follow-up of 18.9 ± 16.6 months post LARS reflected by results of four QOL instruments (RSI − 64%, LPR − 75%, GERD-HRQOL − 80%, SWAL + 18%). The majority of patients demonstrated complete resolution of symptoms upon subsequent encounters with 68% of patients reporting no atypical extraesophageal manifestations during follow-up survey (difficulty breathing − 86%, chronic cough − 81%, hoarseness − 66%, globus sensation − 68%) and 68% of patients no longer taking anti-reflux medication. Seventy-two percent of patients reported being satisfied with their symptom control at latest follow-up. Conclusions: In appropriately selected candidates with atypical GERD symptomatology and objective diagnosis of GERD LARS may afford significant QOL improvements with minimal operative or long-term morbidity.

The aim of this article is to determine entirely the Jordan automorphisms of generalized matrix rings of Morita contexts. Necessary and sufficient conditions are obtained for an R-linear map on a general Morita context to be a Jordan homomorphism. Moreover, some conditions are studied, under which, any Jordan automorphism of a general Morita context is either an automorphism or an anti-automorphism.

Many studies have been devoted to investigating the potential of guided bone regeneration (GBR) membranes for bone defect reconstruction. Regardless of approaches for treating damaged bone tissues, a beneficial therapeutic strategy has remained a challenge. In this study, a novel GBR membrane with polycaprolactone (PCL) and poly(vinyl alcohol) (PVA) containing different concentrations of metformin (Met) for improving osteogenic properties was developed. The membranes were evaluated for their hydrophilicity, degradation rate, swelling ratio, drug release, mechanical properties, and biological responses. The results showed a significant increase in hydrophilicity, swelling ratio, and degradation rate and no significant changes in mechanical properties of PCL/PVA membranes with Met concentration enhancement. A decrease in cell viability cultured on the surface of the PCL/PVA membrane was seen when the amount of Met was changed from 10 to 15 wt %. The results of the in vitroquantitative real-time polymerase chain reaction (qRT-PCR) also confirmed the higher secretion of osteogenic-related genes in a PCL/PVA/Cell/10 wt % Met scaffold than in the PCL/PVA/Cell sample. Therefore, further in vivostudies were conducted using the electrospun PCL/PVA membrane containing human endometrial stem cells (hEnSCs) and 10% Met. Histopathological and histomorphometric results confirmed that PCL/PVA/hEnSCs/10 wt % Met has excellent potential to differentiate hEnSCs into osteogenic lineages and bone regeneration in calvarial defects of rats. The results of this study confirm the high potential of the PCL/PVA/10 wt % Met fibrous membrane preseeded with hEnSCs in GBR applications.

Accumulative structure or cluster-like shape is one of the important features of social networks. These structures and clusters are communities in a complex network and are fully detectable. Common group behaviors of different communities can be categorized using community detection methods. Categorize behavior allows the study of each part of the network to be done centrally. This paper uses trust-based centrality to detect the communities that make up the network. Centrality determines the relative importance of a node in the graph of social networks. Redefining the trust-based centrality makes it possible to change the position in the analysis of centrality and separates the local central nodes and global central nodes. Then, a trust-based algorithm is proposed to express the strength of trust penetration conceptually between nodes to extract communities in networks. This method has led to the achievement of a flexible and effective community detection method. The proposed algorithm is applied to four benchmark networks. The experiments consist of two independent parts. The first part is to use the proposed algorithm to detect clusters and communities. After that, the algorithm is compared with a Girvan–Newman inspired method. The second part is the implementation of the proposed algorithm with a large number of iterations with the aim of modularity maximization and comparing it with other community detection algorithms. Although, the modularity criterion has been used to validate and compare the solution quality in both independent parts of the experiments. The results show about 1.4–5.2% improvement in community detection.

Interfaces have crucial, but still poorly understood, roles in the performance of secondary solid-state batteries. Here, using crystallographically oriented and highly faceted thick cathodes, we directly assess the impact of cathode crystallography and morphology on the long-term performance of solid-state batteries. The controlled interface crystallography, area and microstructure of these cathodes enables an understanding of interface instabilities unknown (hidden) in conventional thin-film and composite solid-state electrodes. A generic and direct correlation between cell performance and interface stability is revealed for a variety of both lithium- and sodium-based cathodes and solid electrolytes. Our findings highlight that minimizing interfacial area, rather than its expansion as is the case in conventional composite cathodes, is key to both understanding the nature of interface instabilities and improving cell performance. Our findings also point to the use of dense and thick cathodes as a way of increasing the energy density and stability of solid-state batteries.

Background: Minimally invasive antireflux surgery has been shown to be safe and effective for the treatment of gastroesophageal reflux (GERD) in elderly patients. However, there is a paucity of data on the influence of advanced age on long-term quality of life (QoL) and perioperative outcomes after laparoscopic antireflux surgery (LARS). Method: A retrospective study of patients undergoing LARS between February 2012 and June 2018 at a single institution was conducted. Patients were divided into four age categories. Perioperative data and quality of life (QOL) outcomes were collected and analyzed. Results: A total of 492 patients, with mean follow-up of 21 months post surgery, were included in the final analysis. Patients were divided into four age-determined subgroups (<?50:75, 50–65:179, 65–75:144,?=?75:94). Advancing age was associated with increasing likelihood of comorbid disease. Older patients were significantly more likely to require Collis gastroplasty (OR 2.09), or concurrent gastropexy (OR 3.20). Older surgical patients also demonstrated increased operative time (ß6.29, p?<?.001), length of hospital stay (ß0.56, p?<?.001) in addition to increased likelihood of intraoperative complications (OR 2.94, p?=?.003) and reoperations (OR 2.36, p?<?.05). However, postoperative QoL outcomes and complication rates were parallel among all age groups. Conclusions: Among older patients, there is a greater risk of intraoperative complications, reoperation rates as well as longer operative time and LOS after LARS. However, a long-term QoL benefit is demonstrated among elderly patients who have undergone this procedure. Rather than serving as an exclusion criterion for surgical intervention, advanced age among chronic reflux patients should instead represent a comorbidity addressed in the planning stages of LARS.

Visual inspection is critical in many maintenance, repair, and overhaul operations and is often the primary defense against premature failure caused by unresolved surface defects. The traditional inspection process is time-consuming and subjective, leading to research into automated systems using computer vision. Several prior methodologies have been developed using convolutional neural networks (CNNs) to classify surface defects; however, these methods often rely on singular models that are sensitive to poor model selection and training errors. Ensembling is a known technique used to minimize the errors of learning algorithms through combining the outputs of multiple models. This paper presents an automated inspection methodology utilizing stacked ensembles of CNNs to classify defects on aircraft surfaces. The proposed framework is evaluated with images obtained from a borescope inspection of aircraft propeller blade bores. It is shown that the ensemble method improves inspection accuracy over conventional single-model deep learning methods. Furthermore, the error reduction provided by the ensemble method reduces false alarms at decision boundaries that minimize missed detections. The proposed method is shown to improve the reliability of automated detection systems, which can avoid catastrophic scenarios on critical systems such as aircraft propellers.

Background: A challenge of laparoscopic surgery is learning how to interpret the indirect view of the operative field. Acquiring professional vision—understanding what to see and which information to attend to, is thereby an essential part of laparoscopic training and one in which trainers exert great effort to convey. We designed a virtual pointer (VP) that enables experts to point or draw free-hand sketches over an intraoperative laparoscopic video for a novice to see. This study aimed to investigate the efficacy of the virtual pointer in guiding novices’ gaze patterns. Methods: We conducted a counter-balanced, within-subject trial to compare the novices’ gaze behaviors in laparoscopic training with the virtual pointer compared to a standard training condition, i.e., verbal instruction with un-mediated gestures. In the study, seven trainees performed four simulated laparoscopic tasks guided by an experienced surgeon as the trainer. A Tobii Pro X3-120 eye-tracker was used to capture the trainees’ eye movements. The measures include fixation rate, i.e., the frequency of trainees’ fixations, saccade amplitude, and fixation concentration, i.e., the closeness of trainees’ fixations. Results: No significant difference in fixation rate or saccade amplitude was found between the virtual pointer condition and the standard condition. In the virtual pointer condition, trainees’ fixations were more concentrated (p= 0.039) and longer fixations were more clustered, compared to the Standard condition (p= 0.008). Conclusions: The virtual pointer effectively improved surgical trainees’ in-the-moment gaze focus during the laparoscopic training by reducing their gaze dispersion and concentrating their attention on the anatomical target. These results suggest that technologies which support gaze training should be expert-driven and intraoperative to efficiently modify novices’ gaze behaviors.

Background: Building on the principles of eTEP access, described by Dr. Jorge Daes, our group has previously described and standardized a novel minimally invasive approach to restoration of the linea alba and repair of lateral atypical defects of the abdominal wall. The purpose of this report is to present comparative analysis of laparoscopic and robotic eTEP access retrorectus repairs. Methods: A retrospective review was conducted in patients who underwent laparoscopic eTEP (lap-eRS) and robotic-assisted eTEP (robo-eRS) Rives-Stoppa repairs between September 2015 and May 2018 at our institution. We analyzed the preoperative demographics and the perioperative outcomes. Results: Our review identified 206 patients (Lap-eRS 120 vs. robo-eRS 86). The groups were comparable (p> 0.05) in gender distribution (47.6% vs. 53% male) and mean age (53.2 vs. 50.8 years), but different (p< 0.05) in mean BMI (31.3 vs. 34.4 kg/m2) and ASA score (2.1 vs. 2.4). The robo-eRS group had a larger defect size (5.5 vs. 7.1 cm, p< 0.05), a longer mean operative time (120.4 vs. 174.7 min, p< 0.05), and a higher hospitalization cost ($5,091 vs. $6,751, p= 0.005) compared to the lap-eRS group. Average length of stay (0.2 vs. 0.1 days), length of drain placement (5.3 vs. 5.7 days), and reoperations (2.5% vs. 2.3%) were similar between lap-eRS and robo-eRS (p> 0.05). Patients in both groups (lap-eRS vs. robo-eRS) were followed for an average of 5.7 months vs. 5.5 months (p= .735) and showed similar recurrence rates (1.7% vs. 1.2%, p> 0.05). Conclusion: We present the largest series to-date of eTEP access laparoscopic and robotic ventral hernia retrorectus repairs. Morbidly obese patients and those with more complex abdominal wall defects were more likely to undergo a robo-eRS. The significantly longer operative time and higher hospital cost associated with the robo-eRS group may be in part due to these factors. Both robotic and laparoscopic eTEP Rives-Stoppa repairs are associated with favorable perioperative outcomes and low recurrence rates.

Background: Cameron lesions (CL) are common complications of large hiatal hernia (HH) disease and are known to result in chronic blood loss with resultant microcytic anemia. There is support in the literature that repair of HH may lead to resolution of CL and restore normal hemoglobin levels. This study aimed to determine the impact of elective HH repair on resolution of anemia and the quality of life (QOL) in patients with CL. Method: A single-institution, retrospective review analyzed all patients with history of CL or anemia (hemoglobin < 12.0 gm/dl in women, < 13.5 gm/dl in men) who underwent HH repair from January 2012 to May 2019. Four validated surveys were used to assess QOL: Reflux Symptom Index (RSI), gastroesophageal reflux disease health-related QOL (GERD-HRQL), laryngopharyngeal reflux health-related QOL (LPR-HRQL), and QOL and swallowing disorders (SWAL) survey. History of iron supplements and perioperative hemoglobin were also noted. Result: Ninety-six patients were included in this study. The mean age was 67.4 ± 10.8 years and 79% of patients were female. CL were endoscopically identified in 61.5% of patients preoperatively, and the rest of the patients experienced anemia of undiagnosed origin but had a high suspicion for CL. Mean follow-up after HH repair was 17.3 months (range, 1 month–5 years). Mean preoperative hemoglobin was 11.01 ± 2.9 gm/dl and 13.23 ± 1.6 gm/dl postoperatively (p< 0.01). Forty-two (73.7%) patients had resolution of anemia during follow-up and 94.5% stopped supplemental oral iron. Finally, QOL scores significantly improved after surgical intervention: RSI (63%), GERD-HRQL (77%), LPR-HRQOL (72%), and SWAL (13%). Conclusion: Elective HH repair in patients with chronic anemia secondary to CL may potentially resolve CL and anemia and contribute to significant QOL improvements. Future studies will prospectively assess the resolution of CL with biochemical and endoscopic follow-up to confirm the preliminary findings of our analysis.

Background: Current literature is conflicted regarding the efficacy of laparoscopic anti-reflux surgery (LARS) among obese patients complaining of pathologic reflux or otherwise symptomatic hiatal hernias. Controlling for other factors, this study examined the influence of preoperative body mass index (BMI) on clinical and subjective quality of life (QOL) outcomes following LARS. Methods: Patients who underwent LARS between February 2012 and April 2018 were subdivided into four BMI stratified categories according to CDC definitions: normal (18.5 to < 25), overweight (25.0 to < 30), obese Class 1 (30 to < 35), and a combination of obese Class 2 (35 to < 40) and Class 3 (≥ 40). Patient demography, perioperative data, and QOL data were collected. QOL was assessed utilizing four validated survey instruments: the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL), Laryngopharyngeal Reflux Health-Related Quality of Life (LPR-HRQL), and a modified Quality of Life in Swallowing Disorders (mSWAL-QOL) surveys. Results: In this study, 869 patients were identified (213 NL, 323 OW, 219 OC1, 114 OC23). The majority of patients in each subgroup were female (65% NL, 68% OW, 79% OC1, 74% OC23) with similar rates of underlying hypertension, hyperlipidemia, and diabetes mellitus. Coronary artery disease rates between groups were statistically significant (p = .021). Operative time, length of hospital stay, and rates of 30-day readmission and reoperation were similar between groups. Among postoperative complications, rates of arrhythmia and UTI were more commonly reported in OC1 and OC23 populations. When assessed utilizing the RSI, GERD-HRQL, LPR-HRQL, and mSWAL-QOL instruments, QOL was similar among all groups (mean follow-up 15 months) irrespective of BMI. Conclusion: These findings suggest LARS in the overweight, obese, and morbidly obese populations—when compared to normal-weight cohorts in short-term follow-up—may have similar value in addressing pathological reflux manifestations and conveying quality of life benefits without added morbidity or mortality.