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Background: Severe accidental hypothermia (AH) accounts for over 1300 deaths/year in the United States. Early extracorporeal life support (ECLS) is recommended for hypothermic cardiac arrest. We describe the use of a rapid-deployment extracorporeal cardiopulmonary resuscitation (E-CPR) team using intensivist physicians (IPs) as cannulators and report the outcomes of consecutive patients cannulated for ECLS to manage cardiac arrest due to AH. Methods: We reviewed all patients managed with veno-arterial (V-A) ECLS for hypothermic cardiac arrest between January 1, 2017 and November 1, 2021. For each patient- age, sex, cause of hypothermia, initial core temperature, initial rhythm, time from arrest to cannulation, cannula configuration, pH, lactate, potassium, cannulation complications, duration of ECLS, hospital length of stay, mortality, and cerebral performance category (CPC) at discharge were reviewed. Results: Nine consecutive patients were identified that underwent V-A ECLS for cardiac arrest due to AH. Seven (78%) were witnessed arrests. Initial rhythm was ventricular fibrillation (VF) in eight patients and pulseless electrical activity (PEA) in one. The mean initial core temperature was 23.8 degrees Celsius. The mean time from arrest to cannulation was 58 min (range 17 to 251 min). There were no complications related to cannulation. The mean duration of ECLS was 39.1 h. All nine patients were discharged alive with a Cerebral Performance score of one or two. Conclusion: In this case series of consecutive patients reporting intensivist-deployed E-CPR for cardiac arrest due to AH, all patients survived to discharge with a favorable neurologic outcome. A rapidly available E-CPR team utilizing intensivist cannulators may improve outcomes in patients with cardiac arrest due to AH.

Goats are a common ruminant in livestock husbandry systems in communal areas of southern Africa, but less so in peri-urban areas. While dynamics of goat farming in the former are relatively well-understood, little is known about it in peri-urban environments. We investigated the contribution of small-scale farming of goats to household livelihoods in rural and peri-urban areas in KwaZulu-Natal Province of South Africa. We used a semi-structured questionnaire survey to elicit views of 115 respondents on the contribution of goats to household income at two rural (Kokstad, Msinga) and two peri-urban (Howick, Pietermaritzburg) locations. Goats contributed to household income as a source of cash and meat in various sociocultural contexts such as at weddings, funerals and festive period gatherings (e.g. Easter and Christmas), including payment for household needs and expenses including food, school fees and medico-cultural consultations. These findings were more pronounced in rural areas, where more goats were kept than in peri-urban areas, which also had smaller herds per household. Goats were a source of cash in numerous ways including sales of their skins after slaughter and use of skins through value addition to make household craft items such as stools that could be sold for cash. None of the farmers milked their goats. Goat famers also kept cattle (52%), sheep (23%) and chickens (67%). Goat ownership appeared to be more profitable in rural areas and contributed to a lesser extent as a source of income in peri-urban areas where goats were largely kept for sale. There is potential for increased value addition of goat products to increase returns from small-scale goat farming in rural and peri-urban settings. Artefacts and cultural symbols derived from goat products are pervasive amongst Zulu people, and represent an additional avenue of research into ‘hidden’ valuation of goats.

Quantifying relationships between animal behavior and habitat use is essential to understanding animal decision-making. High-resolution location and acceleration data allows unprecedented insights into animal movement and behavior. These data types allow researchers to study the complex linkages between behavioral plasticity and habitat distribution. We used a novel Markov model in a Bayesian framework to quantify the influence of behavioral state frequencies and environmental variables on transitions among landcover types through joint use of location and tri-axial accelerometer data. Data were collected from 56 greater white-fronted geese (Anser albifrons frontalis) across seven ecologically distinct winter regions over two years in midcontinent North America. We showed that goose decision-making varied across landcover types, ecoregions, and abiotic conditions, and was influenced by behavior. We found that time spent in specific behaviors explained variation in the probability of transitioning among habitats, revealing unique behavioral responses from geese among different habitats. Combining GPS and acceleration data allowed unique study of potential influences of an ongoing large-scale range shift in the wintering distribution of a migratory bird across midcontinent North America. We anticipate that behavioral adaptations among variable landscapes is a likely mechanism explaining goose use of highly variable ecosystems during winter in ways which optimize their persistence.

Supplemental material, sj-docx-3-jet-10.1177_15266028231165731 for Initial Clinical Experience With AneuFix Injectable Biocompatible Elastomer for Translumbar Embolization of Type 2 Endoleaks by Stefan P. M. Smorenburg, Rutger J. Lely, Bas-Jeroen van Kelckhoven, Erik G. Vermeulen, Kak Khee Yeung, Rombout R. Kruse, Martin Kraai, Chrit M. Stassen, Michael J. Jacobs and Arjan W. J. Hoksbergen in Journal of Endovascular Therapy

Supplemental material, sj-docx-1-jet-10.1177_15266028231165731 for Initial Clinical Experience With AneuFix Injectable Biocompatible Elastomer for Translumbar Embolization of Type 2 Endoleaks by Stefan P. M. Smorenburg, Rutger J. Lely, Bas-Jeroen van Kelckhoven, Erik G. Vermeulen, Kak Khee Yeung, Rombout R. Kruse, Martin Kraai, Chrit M. Stassen, Michael J. Jacobs and Arjan W. J. Hoksbergen in Journal of Endovascular Therapy

Supplemental material, sj-docx-1-jet-10.1177_15266028231165731 for Initial Clinical Experience With AneuFix Injectable Biocompatible Elastomer for Translumbar Embolization of Type 2 Endoleaks by Stefan P. M. Smorenburg, Rutger J. Lely, Bas-Jeroen van Kelckhoven, Erik G. Vermeulen, Kak Khee Yeung, Rombout R. Kruse, Martin Kraai, Chrit M. Stassen, Michael J. Jacobs and Arjan W. J. Hoksbergen in Journal of Endovascular Therapy

Supplemental material, sj-docx-2-jet-10.1177_15266028231165731 for Initial Clinical Experience With AneuFix Injectable Biocompatible Elastomer for Translumbar Embolization of Type 2 Endoleaks by Stefan P. M. Smorenburg, Rutger J. Lely, Bas-Jeroen van Kelckhoven, Erik G. Vermeulen, Kak Khee Yeung, Rombout R. Kruse, Martin Kraai, Chrit M. Stassen, Michael J. Jacobs and Arjan W. J. Hoksbergen in Journal of Endovascular Therapy

Supplemental material, sj-docx-2-jet-10.1177_15266028231165731 for Initial Clinical Experience With AneuFix Injectable Biocompatible Elastomer for Translumbar Embolization of Type 2 Endoleaks by Stefan P. M. Smorenburg, Rutger J. Lely, Bas-Jeroen van Kelckhoven, Erik G. Vermeulen, Kak Khee Yeung, Rombout R. Kruse, Martin Kraai, Chrit M. Stassen, Michael J. Jacobs and Arjan W. J. Hoksbergen in Journal of Endovascular Therapy

Supplemental material, sj-docx-3-jet-10.1177_15266028231165731 for Initial Clinical Experience With AneuFix Injectable Biocompatible Elastomer for Translumbar Embolization of Type 2 Endoleaks by Stefan P. M. Smorenburg, Rutger J. Lely, Bas-Jeroen van Kelckhoven, Erik G. Vermeulen, Kak Khee Yeung, Rombout R. Kruse, Martin Kraai, Chrit M. Stassen, Michael J. Jacobs and Arjan W. J. Hoksbergen in Journal of Endovascular Therapy

We describe the development, implementation, and outcomes of an intensivist-led adult extracorporeal life support (ECLS) program using intensivists both to perform venovenous (V-V), venoarterial (V-A), and extracorporeal cardiopulmonary resuscitation (ECPR) cannulations, and to manage patients on ECLS throughout their ICU course. All adults supported with ECLS at the University of New Mexico Hospital (UNMH) from February 1, 2017 to December 31, 2021 were retrospectively analyzed. A total of 203 ECLS cannulations were performed in 198 patients, including 116 V-A cannulations (including 65 during ECPR) and 87 V-V cannulations (including 38 in patients with COVID-19). UNMH intensivists performed 195 cannulations, with 9 cannulation complications. Cardiothoracic surgeons performed 8 cannulations. Overall survival to hospital discharge or transfer was 46.5%. Survival was 32.3% in the ECPR group and 56% in the non-ECPR V-A group. In the V-V cohort, survival was 66.7% in the COVID-19-negative patients and 34.2% in the COVID-19-positive patients. This large series of intensivist-performed ECLS cannulations-including V-A, V-V, and ECPR modalities-demonstrates the successful implementation of a comprehensive intensivist-led ECLS program. With outcomes comparable to those in the literature, our program serves as a model for the initiation and development of ECLS programs in settings with limited access to local subspecialty cardiothoracic surgical services.

Granulomatosis with polyangiitis (GPA) is a severe systemic vasculitis that commonly affects the paranasal sinuses, upper and lower respiratory tracts, and kidneys. GPA has also been associated with sensorineural hearing loss (SNHL), through inflammation of the cochlear apparatus. Early recognition, diagnostic laboratory evaluation, and appropriate treatment are essential to improve outcomes and achieve remission for patients with GPA. Here, we present a case of bilateral sudden sensorineural hearing loss (SSNHL) and distal symmetric polyneuropathy as the first presenting signs of GPA. A specific diagnostic work-up to rule out autoimmune inner-ear disease in patients with bilateral SSNHL is not clearly stated in the clinical practice guidelines from the American Academy of Otolaryngology-Head and Neck Surgery. The aim of this paper is to delineate an appropriate diagnostic work-up for patients with bilateral SSNHL when there is concern for autoimmune disease.

New approaches are needed to automate and intensify the cultivation of commercially important red macroalgae. For example, cultivation of Gracilaria vermiculophylla on vertically stacked panels, deployed in raceway circulation tanks or in the open ocean, may enable process intensification. A scalable process for panel inoculation is a first step toward this end. Clonal plantlets of G. vermiculophylla were mechanically blended (1000 rpm, 5 s) into tissue fragments of 2 cm nominal size, deposited on a 3-mm polypropylene mesh sheet, and then sprayed with a pressurized water jet at 4.5 bar in 0.1 s bursts with average velocity of 13 m s−1. The force of the water jet pushed the 1 mm diameter thallus tissue fragments into the mesh openings, securing the plantlet to the mesh support. Gracilaria vermiculophylla test panels (7 cm per side) were placed in an upright orientation, with rising air bubbles providing fluid motion over the panel surface. During cultivation at saturation light intensity in nutrient-replete medium, near-exponential growth was sustained over 42 days at a specific growth rate of 8–9% per day, identical to the freely suspended thallus tissues. The tissue fragments proliferated over the panel surface and extended outward from the panel surface, ultimately creating a loose mat of tissue nearly 8–10 cm in thickness and biomass loadings exceeding 3000 g FW per m2 of panel surface. The steps used to prepare the G. vermiculophylla panels can be automated, and dense arrays of stationary G. vermiculophylla panels cultivated under defined current flow offer future potential for process intensification.

The objective of this research is to understand the effectiveness of National Development Agency (NDA) training; the study investigates the effects of training design characteristics (training content) and learning on training effectiveness. The study looked into the effect of training design factor consisting of training content and acquisition of skills and knowledge of trainees on training effectiveness in training program attended by Board members of NPOs in Gauteng Province. About 200 respondents from different NPOs in the Gauteng province of South Africa who attended the NPO Compliance and Governance training participated in the study through an online survey. Training content and learning of trainees have a significant effect on training effectiveness. Furthermore, the respondents indicated that their NPOs did not improve on their poor governance and non-compliance to the NPO Act as a result of the NDA training.

Objectives: To determine the incidence of oronasal fistulas (ONF) associated with primary repair of the anterior palate using a single-layered, superiorly based, vomer mucoperiosteal flap. Design: A systematic review of MEDLINE, PubMed, Cochrane, and Web of Science databases using the keywords: “vomer flap” and “cleft palate repair” were carried out. A meta-analysis was performed using random effect modeling with stratified analysis by syndromic diagnosis, number of surgeons, and mean age. Main Outcome Measure(s): Incidence of ONFs. Results: The meta-analysis included 9 studies with a total of 464 children who met inclusion criteria. The overall ONF rate was 3.0% (95% CI: 1.0-9.0). Fistula rates were not significantly different in studies that included syndromic patients compared to studies that did not, 5.0% (95% CI: 1.0-24.0) versus 3.0% (95% CI: 1.0-6.0), respectively. There was no significant difference between studies in which there was a single surgeon versus multiple surgeons, 3.0% (95% CI: 1.0-13.0) versus 4.0% (95% CI: 1.0-8.0), respectively. Age at the time of cleft repair showed no statistically significant difference in fistula rate when comparing children with a mean age less than 12 months to those greater than 12 months, 3.0% (95% CI: 1.0-5.0) versus 5.0% (95% CI: 1.0-28.0), respectively. Conclusions: The vomer flap technique in cleft palate repair appears to be associated with a low ONF rate unaffected by syndromic diagnosis, number of surgeons, or patient age at time of repair.

Surface-enhanced Raman scattering (SERS) has started to attract attention in vapor sensing; however, practical applications require shorter response time and better sensitivity. Herein, we report a...

Evaluate the utility of whole-body computed tomography (WBCT) imaging in detecting clinically significant findings in patients who have undergone extracorporeal membrane oxygenation (ECMO) cannulation for cardiac arrest (extracorporeal cardiopulmonary resuscitation or "eCPR"). Single-center retrospective review of 52 consecutive patients from 2017 to 2019 who underwent eCPR and received concomitant WBCT imaging. WBCT images were reviewed for clinically significant findings (compression-related injuries, cannulation-related complications, etiology of cardiac arrest, incidental findings, and evidence of hypoxic brain injury) as well as the frequency of interventions performed as a direct result of such findings. Thirty-eight patients met inclusion criteria for analysis. Clinically significant WBCT findings were present in 37/38 (97%) of patients with 3.3 ± 1.7 findings per patient. An intervention as a direct result of WBCT findings was performed in 54% (20/37) of patients with such findings. Evidence of hypoxic brain injury on WBCT was associated with clinical brain death as compared with those without such findings (10/15 [67%] vs 1/22 [4%], P < 0.001), respectively. WBCT scan after eCPR frequently detects clinically significant findings which commonly prompt an intervention directly affecting the patient's clinical course. We advocate for protocolized use of WBCT imaging in all eCPR patients.

When myocardial walls experience stress due to cardiovascular diseases, like heart failure, hormone N-terminal pro-B-type natriuretic peptide (NT-proBNP) is secreted into the blood. Early detection of NT-proBNP can assist diagnosis of heart failure and enable early medical intervention. A simple, cost-effective detection technique such as the widely used fluorescence imaging immunoassay is yet to be developed to detect clinically relevant levels of NT-proBNP. In this work, we demonstrate photonic crystal-enhanced fluorescence imaging immunoassay using diatom biosilica, which is capable of detecting low levels of NT-proBNP in solution with the concentration range of 0˜100 pg/mL. By analyzing the fluorescence images in the spatial and spatial frequency domain with principle component analysis (PCA) and partial least squares regression (PLSR) algorithms, we create a predictive model that achieves great linearity with a validation R2 value of 0.86 and a predictive root mean square error of 14.47, allowing for good analyte quantification. To demonstrate the potential of the fluorescence immunoassay biosensor for clinical usage, we conducted qualitative screening of high and low concentrations of NT-proBNP in human plasma. A more advanced machine learning algorithm, the support vector machine classification, was paired with the PCA and trained by 160 fluorescence images. In the 40 testing images, we achieved excellent specificity of 93%, as well as decent accuracy and sensitivity of 78% and 65% respectively. Therefore, the photonic crystal-enhanced fluorescence imaging immunoassay reported in this article is feasible to screen clinically relevant levels of NT-proBNP in body fluid and evaluate the risk of heart failure.

This study showed that a nanostructured, highly-porous stationary phase composed of randomly-deposited biosilica frustules isolated from living cells of diatom Pinnularia sp. significantly improved the conventional thin-layer chromatography (TLC) based separation of the triphenylmethane dyes malachite green and fast green relative to silica gel by two mobile phases (9:1:1 v/v 1-butanol:ethanol:water, 5:1:2 v/v 1-butanol:acetic acid:water). Although both stationary phases were composed of amorphous silica rich in silanol groups with particle size of 10–12 μm, diatom biosilica frustules were highly porous, hollow shells with surface structure dominated by 200 nm pore arrays. Diatom biosilica significantly improved the mobility of both malachite green and fast green, enabling the resolution of these analytes. The diatom biosilica layer had a high void fraction of 96% but reduced the flow velocity and permeability constant by a factor of two relative to silica gel. TLC performance was enhanced, as evidenced by ten-fold reduction in theoretical plate height for both analytes using the 1-butanol:acetic acid:water mobile phase, and an increased difference in retention time between malachite green and fast green (ΔRf = 0.26) using the 1-butanol:ethanol:water mobile phase. Analysis of plate height vs. solvent front position by the modified van Deemter equation suggested that dispersive mass transfer was reduced, leading to improved analyte resolution, and that surface of the frustule decreased boundary layer resistance, leading to increased analyte flux. Overall, the basis for improved chromatographic performance is believed to be the unique nano- and microstructure of the diatom biosilica frustule.

Tetrahydrocannabinol (THC) is the main active component in marijuana and the rapid detection of THC in human body fluid plays a critical role in forensic analysis and public health. Surface-enhanced Raman scattering (SERS) sensing has been increasingly used to detect illicit drugs; however, only limited SERS sensing results of THC in methanol solution have been reported, while its presence in body fluids, such as saliva or plasma, has yet to be investigated. In this article, we demonstrate the trace detection of THC in human plasma and saliva solution using a SERS-active substrate formed by in situ growth of silver nanoparticles (Ag NPs) on diatom frustules. THC at extremely low concentration of 1 pM in plasma and purified saliva solutions were adequately distinguished with good reproducibility. The SERS peak at 1603 cm-1 with standard deviation of 3.4 cm-1 was used for the evaluation of THC concentration in a methanol solution. Our SERS measurement also shows that this signature peak experiences a noticeable wavenumber shift and a slightly wider variation in the plasma and saliva solution. Additionally, we observed that THC in plasma or saliva samples produces a strong SERS peak at 1621 cm-1 due to the stretching mode of O-C═O, which is related to the metabolic change of THC structures in body fluid. To conduct a quantitative analysis, principal component analysis (PCA) was applied to analyze the SERS spectra of 1 pM THC in methanol solution, plasma, and purified saliva samples. The maximum variability of the first three principal components was achieved at 71%, which clearly denotes the impact of different biological background signals. Similarly, the SERS spectra of THC in raw saliva solution under various metabolic times were studied using PCA and 98% of the variability is accounted for in the first three principal components. The clear separation of samples measured at different THC resident times can provide time-dependent information on the THC metabolic process in body fluids. A linear regression model was used to estimate the metabolic rate of THC in raw saliva and the predicted metabolic time in the testing data set matched well with the training data set. In summary, the hybrid plasmonic-biosilica SERS substrate can achieve ultrasensitive, near-quantitative detection of trace levels of THC in complex body fluids, which can potentially transform forensic sensing techniques to detect marijuana abuse.

Additional file 1.

Paradoxical vocal fold motion disorder, also commonly termed vocal cord dysfunction, is a poorly understood cause of acute upper airway obstruction. Patients with paradoxical vocal fold motion frequently present to the emergency department (ED) with acute respiratory distress and stridor. Lack of familiarity with this disorder may lead to delayed diagnosis or misdiagnosis and unnecessary intubations or surgical airway procedures. Although long-term management of paradoxical vocal fold motion is well described, there is a paucity of information about acute evaluation and management. This article aims to summarize the ED presentation and management of paradoxical vocal fold motion.

Surface-enhanced Raman scattering (SERS) sensing in microfluidic devices, namely optofluidic-SERS, suffers an intrinsic trade-off between mass transport and hot spot density, both of which are required for ultra-sensitive detection. To overcome this compromise, photonic crystal-enhanced plasmonic mesocapsules are synthesized, utilizing diatom biosilica decorated with in-situ growth silver nanoparticles (Ag NPs). In our optofluidic-SERS testing, 100× higher enhancement factors and greater than 1,000× better detection limit were achieved compared with traditional colloidal Ag NPs, the improvement of which is attributed to unique properties of the mesocapsules. First, the porous diatom biosilica frustules serve as carrier capsules for high density Ag NPs that form high density plasmonic hot-spots. Second, the submicron-pores embedded in the frustule walls not only create a large surface-to-volume ratio allowing for effective analyte capture, but also enhance the local optical field through the photonic crystal effect. Last, the mesocapsules provide effective mixing with analytes as they are flowing inside the microfluidic channel. The reported mesocapsules achieved single molecule detection of Rhodamine 6G in microfluidic devices and were further utilized to detect 1 nM of benzene and chlorobenzene compounds in tap water with near real-time response, which successfully overcomes the constraint of traditional optofluidic sensing.

In recent years, researchers have successfully applied diatom biosilica to molecular detection platforms including Surface-Enhanced Raman Scattering (SERS) optofluidic sensors that are currently capable of detecting a variety of biological and chemical molecules at concentrations as low as 10−10 M. This study investigates the feasibility of an SERS device that couples the sensing and pumping capabilities of diatom biosilica thin films by determining flow rate limitations and stability. In this paper, we quantify the ability of porous diatom biosilica thin films to continuously pump deionized (DI) water from a reservoir via wicking flow by utilizing the strong capillary forces of the porous film coupled with evaporation. Our microfluidic device is comprised of a narrow horizontal reservoir fixed to a horizontal capillary whose end contacts a diatom biosilica film. Flow rates were controlled by altering the size and/or temperature of the biosilica porous film, determined by tracking the liquid meniscus displacement in the reservoir, and correlated with a modified laminar boundary-layer model. System stability was observed by tracking flow rates over the course of a given experiment, image analysis of the meniscus contacting the film, and a flow duration study. We found that for untreated DI water bubbles begin to form in the capillary tube at temperatures above 40 °C, but degassed water remains stable at temperatures of 90 °C and below. The pumping capabilities of the films ranged from 0.11 to 10.46 µL/min, matched theoretical predictions, demonstrated stable flow trends, and maintained flow for over 48 h.

Potential magnetic resonance imaging issues for stainless steel sutures used for microtia reconstruction could be clinically significant for safety and diagnostic yield considerations. Therefore, the purpose of this investigation was to assess magnetic resonance issues (magnetic field interactions, heating, and artifacts) for different types of stainless steel sutures used for microtia reconstruction.Small gauge, commonly used stainless steel sutures from four different manufacturers (5/0 Steelex, Aesculap/B, Braun Medical, Inc.; Nagata 38 Gauge Microtia Wire, Bear Medical Corporation; Auricular Reco Wire, Medicon Surgical Inc.; and 5-0 BS 35 Surgical Steel Suture, Ethicon, Inc.) were tested using standardized ex vivo techniques to assess magnetic field interactions, heating, and artifacts at 3 Tesla. Before testing, the stainless steel sutures were configured in a manner same as that for cartilage reconstruction used to treat microtia.Each stainless steel suture exhibited minor magnetic field interactions at 3 Tesla (translational attraction, deflection angle 10°, and no torque). Heating associated with a whole-body averaged specific absorption rate of 2.9 W/kg was not excessive (highest temperature changes, ≤1.8 °C). Artifacts were relatively minor in relation to the size and shape of each stainless steel suture (artifact size in relation to the size and shape of each stainless steel suture extending ≤5 mm).The stainless steel sutures that underwent testing do not present additional risks to patients in a 3-Tesla or less magnetic field setting (i.e., magnetic resonance conditional). Artifacts for these sutures may only be an issue within close proximity to the reconstructed ear.

The University of KwaZulu-Natal, National Research Foundation (Grant: 77582 A.M.S) and National Research Foundation Thuthuka Funding Instrument (Grant: 94021).

OBJECTIVE To compare temporal bone thickness along a three-dimensional arc of potential osseointegrated implant sites for bone-anchored hearing aids in children with and without aural atresia using computed tomographic imaging (CT). STUDY DESIGN Retrospective case review. SETTING Tertiary children's hospital. PATIENTS Children with or without aural atresia aged less than 11 years who had a temporal bone CT. INTERVENTION (S) Calvarial bone volume on CT was rendered in three-dimensional and thickness was reconstructed and measured at up to 12 defined sites along an arc of recommended implant sites. MAIN OUTCOME MEASURE (S) Determining whether a majority of observed potential implant sites have 2, 3, or 4 mm of bone thickness while controlling for age differences and atresia status. RESULTS A total of 40 atretic (from 34 patients) and 34 control (from 34 patients) temporal bones were compared using CT. Likelihood ratio tests indicated that diagnosis did not have a statistically significant effect on whether patients reached thresholds of 2, 3, or 4 mm at most observed sites (p = 0.781, 0.773, and 0.529, respectively) when adjusting for age. For all children measured, 93% had >50% of measured points greater than or equal to 2 mm thick. CONCLUSION Most children had greater than 2 mm of temporal bone thickness at >50% of the sites measured regardless of age or atresia diagnosis. The likelihood of reaching 4 mm of thickness at most sites improves with age. In unilateral patients, there was not a significant difference in thickness between affected and unaffected sides. There was also no significant difference in thickness when comparing patients with atresia to those without.

This article discusses a qualitative study that focused on the experiences of 27 students majoring in special education who completed a service-learning course on intellectual and developmental disabilities. In the course, each student was paired with an individual with an intellectual and developmental disability, and engaged in weekly recreational activities exploring the local community. Through their study, the authors sought to understand three main phenomena. First, they explored the connection between service-learning and increased understanding about individuals with intellectual and developmental disabilities. Second, they investigated whether course content paired with service-learning impacted students’ desire to pursue a career in special education. Finally, the authors examined the relationship between service-learning and the development of work-related skills in the field. Findings revealed that strengthening the connection between service-learning and special education not only reaffirmed students’ career choices but also equipped them with skills to continue serving as educators.

Treatment of massive pulmonary embolism (MPE) is controversial, with mortality rates ranging from 25% to 65%. Patients commonly present with profound shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used as a form of acute cardiopulmonary support in critically ill patients. We reviewed our institution's pulmonary embolism response team experience using VA-ECMO for patients presenting with advanced shock and/or cardiac arrest from MPE.From March 2017 to July 2019 we retrospectively reviewed 17 consecutive patients at our institution with MPE who were placed on VA-ECMO for initial hemodynamic stabilization.The mean patient age and body mass index was 55.8 years and 31.8, respectively. Ten of 17 patients (59%) required cardiopulmonary resuscitation before or during VA-ECMO cannulation. All patients had evidence of profound shock with a mean initial lactate of 8.95 mmol/L, a mean pH of 7.10, and a mean serum creatinine of 1.78 mg/dL. Seventeen of 17 cannulations (100%) were performed percutaneously, with 41% (n = 7) of patients placed on VA-ECMO while awake and using local analgesia. Five of 17 patients (29%) required reperfusion cannulas, with 0% incidence of limb loss. Overall survival was 13 of 17 patients (76%), with causes of death resulting from anoxic brain injury (n = 2), septic shock (n = 1), and cardiopulmonary resuscitation-induced hemorrhage from liver laceration (n = 1). In survivors, 12 of 13 patients (92%) were discharged without evidence of neurologic insult. The median duration of the VA-ECMO run for survivors was 86 hours (range, 45-218 hours). In survivors, the median length of time from ECMO cannulation to lactate clearance (2.0 mmol/L) was 10 hours and the median length of time from ECMO cannulation to freedom from vasopressors was 6 hours. Three of 13 patients (23%) required concomitant percutaneous thrombectomy and catheter-directed thrombolysis to address persistent right heart dysfunction, with the remaining survivors (77%) receiving VA-ECMO and anticoagulation alone as definitive therapy for their MPE. The median intensive care and hospital length of stay for survivors was 9 and 13 days, respectively.VA-ECMO was effective at salvaging highly unstable patients with MPE. Survivors had rapid reversal of multiple organ failure with ECMO as their primary therapy. The majority of survivors required ECMO and anticoagulation alone for definitive therapy of their MPE.

An infant with severe congenital laryngomalacia presented with inspiratory stridor when feeding, crying, or supine, relieved by prone or upright repositioning. Suprasternal retractions, hypoxemia, feeding difficulties, and failure to thrive prompted admission to the pediatric intensive care unit. Symptoms of sleep disordered breathing contributed to the severity of her laryngomalacia. Overnight polysomnography confirmed severe obstructive sleep apnea and sleep-related hypoxemia. The patient underwent supraglottoplasty with resolution of the wake hypoxemia but with residual stridor and apnea. Revision supraglottoplasty led to remission of the stridor and obstructive sleep apnea but emergence of central sleep apnea. This case discusses the clinical features, diagnostic evaluation, and management of congenital laryngomalacia. Supraglottoplasty, reserved for infants with moderate or severe laryngomalacia, is the treatment of choice. Obstructive sleep apnea improves but usually does not fully remit after supraglottoplasty. Central sleep apnea is not uncommon in infants with laryngomalacia and may reflect immature or abnormal brainstem nuclei regulating regulation of respiration during sleep.

Diatoms are a group of single-celled photosynthetic algae that use biochemical pathways to bio-mineralize and self-assemble three-dimensional photonic crystals with unique photonic and micro- & nano-fluidic properties. In recent years, diatom biosilica has been used in surface-enhanced Raman scattering (SERS) based optofluidic sensors for detection of a variety of chemical and biological molecules. In this paper, we present a study to develop a microfluidic pumping system using super-hydrophilic diatom thin films. The desire to develop such a system stems from the requirement to create a low-cost, self-powered microfluidic pumping system that can sustain a continuous flow over an extended period of time. The diatom biosilica acts not only as the driving force behind the flow, but also serves as ultra-sensitive SERS substrates that allows for trace detection of various molecules. Liquid is drawn from a reservoir to the tip of a 150μm inner diameter capillary tube positioned directly over the diatom film. A thin and long horizontal reservoir is used to prevent flooding on the diatom film when the liquid is initially drawn to the diatom film through a capillary tube from the reservoir. The connection of the meniscus from the capillary to the film was maintained from a horizontal reservoir for a recorded time of 20 hours and 32 minutes before the partially filled reservoir emptied. Flow rates of 0.38, 0.22 and 0.16μL/min were achieved for square biosilica thin films of 49mm2, 25mm2, and 9mm2 at a temperature of 63°F and 45% relative humidity respectively. A temperature-controlled system was introduced for the 49mm2 substrate and flow rates of 0.60, 0.82, 0.93, and 1.15μL/min were observed at 72, 77, 86, and 95°F at 21% relative humidity respectively. More testing and analysis will be performed to test the operation limits of the proposed self-powered microfluidic system.

This study investigated the feasibility of cultivating clonal red macroalgae on a porous mesh support. Clonal plantlets of macrophytic red alga Ochtodes secundiramea served as the model culture system. The morphology of O. secundiramea is defined by highly-branched shoot tissues. Plantlets were mechanically blended (8000 rpm, 7 s) and allowed to recover for 7 days prior to immobilization. A 2.0 g FW L−1 slurry of 3 mm branched shoot tissues was injected onto a fiberglass mesh with 1.6 mm openings in 0.5 s bursts at pressure of 8 bar and nominal fluid velocity of 1.7 m s−1. Each burst deposited a 25 mg shoot tissue cluster onto the mesh. Clusters were placed on a rectangular pitch at decreasing intervals of 20, 12, 8, and 6 mm (contiguous layer) in order to increase the inoculation density. A parallel array of upright, plantlet-inoculated mesh panels was positioned at the base of an aerated, externally illuminated tank, and enriched artificial seawater medium flowed across both sides of each panel. Biomass growth was linear with time, and increased by a factor of 10 over the 28 day cultivation period. Increasing panel inoculation density from 49 to 114 g FW m−2 panel mesh area doubled panel biomass productivity from 14.5 to 28.6 g FW m−2 day−1. Immobilized plantlets proliferated outward across the mesh surface to form a highly branched, densified shoot tissue mass about 1.5 cm thick, and final panel biomass coverage exceeding 3.0 kg FW per m2 of active panel area was achieved. Overall, the outcomes of this study demonstrate that pressurized fluid injection of clonal plantlets onto a mesh surface, and the subsequent proliferation of the shoot tissues on the mesh to form a contiguous panel, offers potential for the future automation and intensification of red macroalgal biomass production.

Aim: It is still unclear whether telemonitoring reduces hospitalization and mortality in heart failure (HF) patients and whether adding an Information and Computing Technology-guided-disease-management-system (ICT-guided-DMS) improves clinical and patient reported outcomes or reduces healthcare costs. Methods: A multicenter randomized controlled trial was performed testing the effects of INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) with in total 179 patients (mean age 69 years; 72% male; 77% in New York Heart Association Classification (NYHA) III-IV; mean left ventricular ejection fraction was 28%). Patients were randomized to ICT-guided-DMS or to ICT-guided-DMS + telemonitoring with a follow-up of nine months. The composite endpoint included mortality, HF-readmission and change in health-related quality of life (HR-QoL). Results: In total 177 patients were eligible for analyses. The mean score of the primary composite endpoint was -0.63 in ICT-guided-DMS vs. -0.73 in ICT-guided-DMS + telemonitoring (mean difference 0.1,95% CI: -0.67 +0.82, p = 0.39). All-cause mortality in ICT-guided-DMS was 12% versus 15% in ICT-guided-DMS + telemonitoring (p = 0.27); HF-readmission 28% vs. 27% p = 0.87; all-cause readmission was 49% vs. 51% (p = 0.78). HR-QoL improved in most patients and was equal in both groups. Incremental costs were 1360 in favor of ICT-guided-DMS. ICT-guided-DMS + telemonitoring had significantly fewer HF-outpatient-clinic visits (p < 0.01). Conclusion: ICT-guided-DMS + telemonitoring for the management of HF patients did not affect the primary and secondary endpoints. However, we did find a reduction in visits to the HF-outpatient clinic in this group suggesting that telemonitoring might be safe to use in reorganizing HF-care with relatively low costs. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://cleativecommons.org/licenses/by-nc-nd/4.0/). Funding Agencies|Dutch Ministry of Health, Department of Pharmaceutical Affairs and Medical Technology (GMT)

Chronic granulomatous disease (CGD) is a rare condition that manifests as recurrent, severe and life-threatening infections. We present a rare case of recurrent multifocal abscesses and respiratory embarrassment from retropharyngeal abscesses in a child with CGD, and discuss the aetiology, presentation and management of this condition.

This paper discusses the inability of successful land claimants to enjoy livelihood benefits from their newly acquired land rights. Based on long-term field observation, interviews and analysis of secondary material, the paper uses a case study of the Dwesa-Cwebe Nature Reserve in the Eastern Cape Province of South Africa to explore why it is that an agreement, as part of the land claim settlement, to allow local villagers regulated access to natural resources is not being implemented. The paper draws from the environmental entitlements framework to argue that full land rights that could allow livelihood benefits to be enjoyed are restricted by ineffective and conflicting institutional arrangements, such as the Land Trust, the Communal Property Association and traditional authorities. The paper calls for the empowerment of institutions to deliberately benefit local livelihoods.

Wintering diving duck (Aythya spp.) time-activity budgets have been developed for many species in different regions. As such, direct comparisons can be made among studies where substantial deviations in “normal” activity budgets can provide insight as to how location, food resources, habitat, weather and human disturbance may differentially influence behavior (s) during winter. To examine how diving ducks use large reservoirs in eastern Texas, 1,275 individual time-activity budgets were quantified for Canvasback (Aythya valisineria), Lesser Scaup (A. affinis) and Ring-necked Duck (A. collaris) wintering on B.A. Steinhagen, Sam Rayburn and Toledo Bend Reservoirs during winter 2003/2004 and 2004/2005. Behaviors varied among species (P< 0.001), where food acquisition, locomotion and resting-related behaviors dominated time-activity budgets. All three species spent similar time feeding compared to other studies in the southeastern United States, but spent substantially more time locomoting than prev...