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This study was aimed to assess whether facial asymmetry increases with age and to examine potential gender differences using 3D stereophotogrammetry. A prospective cross-sectional study was performed. 3D photographs were acquired from 600 control subjects, 300 male, 300 female, and were stratified into 15 different age groups ranging from 0 to 70+. The 3D photographs were postprocessed and mirrored. The original and mirrored faces were surface-based matched using an iterative closest point algorithm. The primary outcome variable, facial asymmetry, was evaluated by calculating the absolute mean distance between the original and mirrored images. The primary predictor was age. Pearson's correlation was used to assess the correlation between facial asymmetry and age. The average overall facial asymmetry was 0.72 mm (SD 0.72 mm; range 0.25 – 3.04 mm). Mean facial asymmetry increased significantly with age, from 0.45 mm in the age group of 0-4 years to 0.98 mm in the age group of 70+ (p<0.001). Facial asymmetry was positively correlated with age (Pearson's r = 0.55; p<0.001). Male subjects were significantly more asymmetric compared to females, 0.77 mm and 0.67 mm, respectively (p<0.001). This study indicates that facial asymmetry significantly increases with age and is significantly larger in males than in females. [ABSTRACT FROM AUTHOR]

Musculoskeletal disorders (MSDs), often caused by working in non-ergonomic circumstances, are the most important category of work-related diseases. Different methods exist for examining ergonomics through a variety of postural evaluation techniques (e.g. Rapid Entire Body Assessment (REBA)), which are mostly performed through manual survey-based observations. Consequently, measuring ergonomics of operators is time-consuming and happens only sporadically, often after problems occur. Furthermore, as an ergonomist must assign a score to the performed activity, the ergonomics evaluation is subjective. These problems can be resolved by continuous and automated ergonomic load monitoring methods that directly provide feedback to operators. In order to monitor the operator without interfering the task at hand, a vision-based ergonomics monitoring system is developed. Here, ergonomic features (e.g. joint angles) are estimated based on multiple video streams, which are used to calculate an objective ergonomic score using a standard ergonomics evaluation technique. Although cognitive operator support systems (i.e. digital work instructions) for manual assembly environments are widely used, they do typically not include ergonomics information. The goal of the methodology presented in this work is to a) formulate or update digital work instructions, b) provide the operator feedback on its ergonomic soundness via work instructions and c) generate ergonomic risk level reports in an automated way based on the outcomes of the vision-based ergonomics evaluator. Making the ergonomic guidelines context-aware ensures that interventions occur at the right time. The methodology is integrated in a framework for context-aware work instructions and is validated via a proof of concept, based on an actual industrial case. Results show that context-awareness enhances user acceptance and ergonomics of the operator. [ABSTRACT FROM AUTHOR]

Background: Pathological Q waves are correlated with infarct size, and Q-wave regression is associated with left ventricular ejection fraction improvement. There are limited data regarding the association of Q-wave regression and clinical outcomes. Our main objective was to assess the association of pathological Q wave evolution after reperfusion with clinical outcomes after anterior STEMI.Methods: Standard 12-lead electrocardiograms (ECGs) were recorded in 780 anterior STEMI patients treated with primary percutaneous coronary intervention (PCI) from the CIRCUS trial. ECGs were recorded before and 90 min following PCI, as well as at hospitalization discharge and 12 months of follow-up. The number of classic ECG criteria Q waves was scored for each ECG. Patients were classified in the Q wave regression group if they had regression of at least one Q wave between the post-PCI, the discharge and/or one year ECGs. Patients were classified in the Q wave persistent group if they had the same number or greater between the post-PCI, the discharge and/or 1 and one year ECGs. All-cause death and heart failure events were assessed for all patients at one year.Results: There were 323(43%) patients with persistent Q waves (PQ group), 378(49%) patients with Q wave regression (RQ group) and 60(8%) patients with non-Q wave MI (NQ group). Infarct size as measured by the peak creatine kinase was significantly greater in the PQ group compared to the RQ and NQ groups (4633 ± 2784 IU/l vs. 3814 ± 2595 IU/l vs. 1733 ± 1583 IU/l respectively, p < 0.0001). At one year, there were 22 deaths (7%) in the PQ-group, 15 (4%) in the RQ-group and none in the NQ-group (p = 0.04). There was a 4-fold increase in the risk of death or heart failure in the PQ compared to the NQ group (HR 4.7 [1.1; 19.3]; p = 0.03), but there was no significant difference between NQ and RQ groups (HR 3.3 [0.8; 13.8]; p = 0.09).Conclusion: In a population of anterior STEMI patients, persistent Q waves defined according to the classic ECG criteria after reperfusion was associated with a 4-fold increase in the risk of heart failure or death compared to non-Q-wave MI, while Q-wave regression was associated with significantly lower risk of events. [ABSTRACT FROM AUTHOR]

Antlers are bony structures composed predominantly of primary osteons with unique mechanical properties due to their specific use by deer as weapon and shield. Antler bone fracture resistance has attracted prior scrutiny through experimental tests and theoretical models. To characterize antler mechanical properties, compression of cubes, or bending or tensioning of rectangular bars have been performed in the literature with variations in the protocols precluding comparisons of the data. Compression testing is a widely used experimental technique for determining the mechanical properties of specimens excised from cortical or cancellous regions of bone. However, the recommended geometry for compression tests is the cylinder, being more representative of the real performances of the material. The purpose of research was to report data for compressive strength and stiffness of antler cortical bone following current guidelines. Cylinders (n = 296) of dry antler cortical bone from either the main beam or the tines of Cervus elaphus , Rangifer tarandus , Cervus nippon and Dama dama were tested. This study highlights the fact that compression of antler cortical bone cylinders following current guidelines is feasible but not applicable in all species. Standardization of the testing protocols could help to compare data from the literature. This study also confirms that sample localization has no effect on the mechanical properties, that sample density has a significant impact and allows enriching the knowledge of the mechanical properties of dry antler cortical bone. • Compression of cylindrical specimens is more representative than other geometrical shape. • Compression of antler cortical bone cylinders is feasible but may be not applicable in all species. • Sample density has a significant impact on antler cortical bone mechanical properties. • Sample localization (main beam vs tines) has no effect on antler cortical bone mechanical properties. • Comparison of antler cortical bone compressive strength and stiffness from different species. [ABSTRACT FROM AUTHOR]

Myositis-specific autoantibodies (MSAs) are thought to be mutually exclusive in patients with idiopathic inflammatory myopathies (IIM) based on studies with immunoprecipitation-based (IP) detection methods. Recently, detection of multiple MSAs in unique patients is increasingly reported, but the extent of this phenomenon remains unclear. At our centre, we reviewed results from two line immunoassays and one dot immunoassay in 145 IIM patients and 240 controls for the presence of multiple MSAs. Pubmed and Embase were systematically searched for articles mentioning detection of multiple MSAs in IIM patients, published until February 2019. We assessed the frequency, detection method, the precise combinations and clinical phenotypes of participants with multiple MSAs. At our centre, detection of multiple MSAs occurred in 3.4-8.3% of patients with IIM, depending on the assay. However, no cases with full concordance across all three assays were identified. Forty-four articles reported detection of multiple MSAs, representing a total of 133 cases, including four patients with a connective tissue disease other than IIM and two healthy controls. In 101 cases all MSAs were detected using only one detection method: 40 cases with IP-based methods (most frequently used technique) and 61 cases with other assay types. In most cases the phenotype of patients with multiple MSAs matched the predicted presentation associated with one MSA and in few cases the phenotype matched with both MSAs. Detection of multiple MSAs in unique IIM patients is less rare than commonly accepted. Specificity issues of the commercially available multiplex immunoassays may, at least partly, explain the higher frequency compared to IP-based methods. 'True multiple MSA-positive' patients may exist, though they are most likely rare. [ABSTRACT FROM AUTHOR]

As the advances in medicine continue to emerge, more children with congenital or pediatric-onset chronic urologic conditions are surviving well into adulthood. This imposes an ever rising there is a need for adequate transition of these patients from pediatric to adult care. Despite position statements from multiple heath care organizations and several models proposed in literature, different issues and gaps in urologic transition continue to exist. Major barriers in this transition are adolescence, a challenging time that is characterized by impulsive behavior and risk taking, and the longstanding relation between both patients and paediatric providers. Both pediatric and adult care providers need to be aware of the special needs of maturing youth with chronic care problems related to education, self-management, legal issues and psychological support during care transition. Furthermore, they need to understand and address the currently existing obstacles for adequate transition. There is need for active communication with each other and the patient to develop sustainable relationships that can support the transitioning process. It is therefore in the greatest interest of the care provider to make this transition as smooth as possible. This paper aims to point out the currently perceived barriers in care transition within the urological context, reflect on previous implemented models for care transition and present proposals for improvement. [ABSTRACT FROM AUTHOR]

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The Late Paleozoic tectono–magmatic history and basement of the Maya block are poorly understood due to the lack of exposures of coeval magmatic rocks in the region. Recently, IODP–ICDP Expedition 364 recovered drill core samples at borehole M0077A from the peak ring of the Chicxulub impact crater, offshore of the Yucatán peninsula in the Gulf of México, have been studied comprehensively. In the lowermost ~600 m of the drill core, impact–deformed granitoids, and minor felsite and dolerite dykes are intercalated with impact melts and breccias. Zircon U-Pb dating of granitoids yielded ages of around 326 ± 5 Ma, representing the first recovery of Late Paleozoic magmatic rocks from the Maya block, which could be genetically related to the convergence of Laurentia and Gondwana. The granitoids show the features of high K 2 O/Na 2 O, La N /Yb N and Sr/Y ratios, but very low Yb and Y contents, indicating an adakitic affinity. They are also characterized by slightly positive ԑNd (326Ma) of 0.17–0.68, intermediate initial 87Sr/86Sr (326Ma) of 0.7036–0.7047 and two–stage Nd model age (T DM2) of 1027–1069 Ma, which may indicate a less evolved crustal source. Thus, the adakitic granitoids were probably generated by partial melting of thickened crust, with source components similar to Neoproterozoic metagabbro in the Carolina block (Pan–African Orogeny materials) along Peri–Gondwana. Felsite dykes are shoshonitic with typical continental arc features that are sourced from a metasomatic mantle wedge by slab–fluids. Dolerite dykes display OIB–type features such as positive Nb and Ta anomalies and low Th Npm /Nb Npm. In our interpretation, the Chicxulub adakitic granitoids of this study are formed by crustal anatexis due to asthenospheric upwelling resulting from slab breakoff. Through comparing sources and processes of Late Paleozoic magmatism along the Peri–Gondwanan realm, a tearing slab breakoff model may explain the discontinuous magmatism that appears to have occurred during the convergence of Laurentia and Gondwana. Unlabelled Image • Continuous drill core investigation through Late Paleozoic granitoids from the Maya block • Adakitic affinity related to partial melting of thickened crust • Basement uplifted by Chicxulub impact mainly comprises the Pan–African rocks. • Magmatism correlate to slab breakoff along the Peri–Gondwanan realm [ABSTRACT FROM AUTHOR]

The bladder-Exstrophy-Epispadias complex (BEEC) contains a wide spectrum of congenital malformations. A treatment naïve refugee was referred to our center with what was identified as BEEC. A 27-year-old female patient was referred for total incontinence since birth by the general practitioner from the refugee center. An exstrophic bladder with blind ending ureteral orifices and a second non-exstrophic bladder with two orthotopic ureters was identified, demonstrating the bladder duplication in the sagittal plane. Laparotomy was performed, dissecting the exstrophic bladder plate caudally and using it as a ventral onlay to augment the non-exstrophic bladder. A Mitchell-type bladder neck reconstruction was performed with an autologous fascia sling around the bladder neck to obtain continence. As the patient had never voluntarily voided, chances of spontaneous voiding after surgery were low. Therefore creation of a continent Mitrofanoff-type vesicostomy was additionally realized and genital reconstruction was achieved. 12 months post operatively, the patient was completely continent, had a bladder capacity of 250 ml, and performed self-catheterization 5 times a day. No post-operative complications were observed. Admission of political refugees can implicate challenging surgeries for congenital malformations in adults, such as BEEC. This demonstrates the importance of multidisciplinary transitional care. [ABSTRACT FROM AUTHOR]

Pyeloplasty (open or Robot-assisted) is the gold standard of a symptomatic UPJ stenosis. Sometimes anatomic variants make the procedure challenging. This video describes a step-by-step approach in three settings: a crossing blood vessel and two different presentations of incomplete duplicated system. Under general anesthesia, patient positioned in lateral decubitus, three trocars are placed. After mobilization of the colon, the Gerota's fascia is opened, and the renal pelvis is dissected off the surrounding structures. Ureter and obstructed pyelum were subsequently identified, mobilized, and hinged on a traction stitch. The pyelum and ureter are divided and spatulated according to the Anderson-Hynes technique; anastomosis is achieved. In variants, the drainage is one of the challenging steps, needing custom-made drainage of both moieties. Correct positioning of the drainage is confirmed with reflux of methylene blue from the bladder. JJ stent was removed 6 weeks postoperatively in surgical day-clinic, additional drainage was removed 1 week after surgery in the outpatient clinic. All three children remain asymptomatic with over a year of follow-up. A step-by-step plan for pyeloplasty in case of anatomic variants is presented with a video demonstrating a robot-assisted approach in duplicated systems. Moiety drainage can be challenging. [ABSTRACT FROM AUTHOR]

This study was a comprehensive evaluation of cardiopulmonary function in patients with chronic thromboembolic (pulmonary vascular) disease (CTED) during exercise. Exertional dyspnea is frequent following pulmonary embolism, but only a minority of patients eventually develops chronic thromboembolic pulmonary hypertension (CTEPH). Better understanding of the factors that limit exercise capacity in patients with persistent pulmonary artery obstruction could help to further define the entity of CTED. Fifty-two subjects (13 healthy control subjects, 14 CTED patients, and 25 CTEPH patients) underwent cardiopulmonary exercise testing and exercise cardiac magnetic resonance with simultaneous invasive pressure registration. Pulmonary vascular function and right ventricular contractile reserve were assessed through combined invasive pressure measurements and magnetic resonance imaging volume measures. Exercise capacity was reduced by 29% and 57% in patients with CTED and CTEPH respectively, compared with control subjects. Both CTED (3.48 [interquartile range: 2.24 to 4.36] mm Hg × l−1 × min−1) and CTEPH patients (8.85 [interquartile range: 7.18 to 10.4] mm Hg × l−1 × min−1) had abnormal total pulmonary vascular resistance. Right ventricular contractile reserve was reduced in CTED patients compared with control subjects (2.23 ± 0.55 vs. 3.72 ± 0.94), but was still higher than that in CTEPH patients (1.34 ± 0.24; p < 0.001). As opposed to patients with CTEPH in whom right ventricular ejection fraction declined with exercise, right ventricular ejection fraction still increased in patients with CTED, albeit to a lesser extent than in healthy control subjects (interaction p < 0.001), which illustrated the distinct patterns of ventricular−arterial coupling. CTED represents an intermediate clinical phenotype. Exercise imaging unmasks cardiovascular dysfunction not evident at rest and identifies hemodynamically significant disease that results from reduced contractile reserve or increased vascular load. [ABSTRACT FROM AUTHOR]

The cardiovascular disease (CVD) pandemic has placed considerable strain on healthcare systems, quality of life, and physical function, while remaining the leading cause of death globally. Decades of scientific investigations have fortified the protective effects of cardiorespiratory fitness (CRF), exercise training, and physical activity (PA) against the development of CVD. This review will summarize recent efforts that have made significant strides in; 1) the application of novel analytic techniques to increase the predictive utility of CRF; 2) understanding the protective effects of long-term compliance to PA recommendations through large cohort studies with multiple points of assessment; 3) and understanding the potential harms associated with extreme volumes of PA. [ABSTRACT FROM AUTHOR]

Abstract Pelagic carbonate sections constitute common archives for paleoclimatological and stratigraphical research. This study evaluates the use of portable X-ray fluorescence (pXRF) measurements on pelagic carbonates and applies the method to the well-studied latest Maastrichtian in the Bottaccione Gorge section from Gubbio, Italy. A calibration with carbonate reference materials makes it possible to acquire absolute elemental concentrations, and allows for comparison with results from previous geochemical studies, which used more expensive and time consuming conventional techniques, such as neutron activation or Inductively Coupled Plasma Mass Spectrometry (ICP-MS). With adequate measurement strategies and careful calibration, pXRF measurements can be a reliable, non-destructive, cheap, fast and easy to use alternative to acquire multi-elemental concentration data (Ca, Fe, Mn, Sr) in pelagic carbonates. These pXRF elemental concentration data represent valuable additions to classical proxies such as magnetic susceptibility and calcium carbonate content used in the study of pelagic carbonates. Furthermore, the potential of the portable pXRF method for applications in cyclostratigraphical (e.g. using Fe-concentrations) and chemostratigraphical (e.g. using Mn and Sr concentrations) investigations is demonstrated. A strong covariation between the measured Sr concentration profile obtained by pXRF and the existing δ18O record, in combination with micro-XRF mapping, demonstrated the sampling of calcite veins in some of the samples. The first 87Sr/86Sr isotope measurements for the latest Maastrichtian in the Bottaccione Gorge section seem to be little affected by this sampling effect. [ABSTRACT FROM AUTHOR]

Numerous investigations have established the strong clinical utility of cardiac rehabilitation, while clinical guidelines continually call for a high level of referral and participation. Historically, medical facilities have faced challenges referring eligible patients to cardiac rehabilitation, enrolling only a small portion of those receiving referral. Consequently, less than ~10% of qualifying patients receive any amount of cardiac rehabilitation. This sobering figure has prompted many efforts to identify barriers to referral as well as enrollment and accordingly propose strategies to bolster participation rates. Although reports have highlighted improvements through focused approaches, enrollment rates still lag behind the goal of reaching 70% by 2022, proposed by the Million Hearts Cardiac Rehabilitation Collaborative. An area of inquiry that has received little to no attention in this effort has been the influence of proximity between physician-driven outpatient clinics and cardiac rehabilitation facilities. In this report we outline the development and design of a clinical faculty practice aimed to maintainclose geographical proximity between our physicianclinic and the cardiac rehabilitation area. We also propose that our impressive enrollment rates of 57% within our facility and 73% when including patients that started alternative exercise programs were likely due to establishing a close proximity between the respective practices. [ABSTRACT FROM AUTHOR]

Abstract This study evaluated the impact of class III correction by elastic traction on four miniplates and the failure rate of bone-anchored miniplates in nonsyndromic patients. A total of 218 patients (112 males and 106 females; average 11.4 years), treated by 38 orthodontists, received four miniplates (total 872 miniplates) from 2008 to 2016 at three maxillofacial centers in two countries. Factors affecting the success and failure of the miniplates were retrospectively examined and skeletal changes on cephalometric radiographs examined for 52 patients. Elastic traction was performed for 22.9 months, on average. The miniplate survival rate was 93.6%; 25.7% of the patients suffered failure of one of the miniplates. Postoperative antibiotics and placement of the neck of the miniplate in the attached gingiva significantly improved the success rate. Miniplate failure was six times higher in the maxilla and occurred more in younger patients. Self-drilling screws were significantly better than self-tapping screws for fixing the miniplate. Small cephalometric changes were seen: SNA (+1.9°), SNB (+0.4°), ANB (+1.4°), Wits analysis (+1.3 mm). In conclusion, bone-anchored maxillary protraction on four miniplates is an effective method for correcting a class III relationship, but has less skeletal effect than previously reported in the literature. [ABSTRACT FROM AUTHOR]

Background: Fragmented QRS (fQRS) on a 12-lead ECG has been linked with adverse outcome. However, the visual scoring of ECGs is prone to inter- and intra-observer variability.Methods: Five observers, two experienced and three novel, assessed fQRS in 712 digital ECGs, 100 were re-evaluated to assess intra-observer variability. Fleiss and Cohen's Kappa were calculated and compared between subgroups.Results: The inter-observer variability for assessing fQRS in all leads combined was substantial with a Kappa of 0.651. Experienced observers only had a better agreement with a Kappa of 0.823. Intra-observer variability ranged from 0.736 to 0.880. In the subgroup with ventricular pacing the inter-observer variability was even significantly larger when compared to ECGs with normal QRS duration (Kappa 0.493 vs 0.664, p<0.001).Conclusion: The visual assessment of QRS fragmentation is prone to inter- and intra-observer variability, mainly influenced by the experience of the observers, the underlying rhythm and QRS morphology. [ABSTRACT FROM AUTHOR]

The Many Hosts of Mycobacteria (MHM) meeting series brings together basic scientists, clinicians and veterinarians to promote robust discussion and dissemination of recent advances in our knowledge of numerous mycobacterial diseases, including human and bovine tuberculosis (TB), nontuberculous mycobacteria (NTM) infection, Hansen's disease (leprosy), Buruli ulcer and Johne's disease. The 9th MHM conference (MHM9) was held in July 2022 at The Ohio State University (OSU) and centered around the theme of "Confounders of Mycobacterial Disease." Confounders can and often do drive the transmission of mycobacterial diseases, as well as impact surveillance and treatment outcomes. Various confounders were presented and discussed at MHM9 including those that originate from the host (comorbidities and coinfections) as well as those arising from the environment (e.g., zoonotic exposures), economic inequality (e.g. healthcare disparities), stigma (a confounder of leprosy and TB for millennia), and historical neglect (a confounder in Native American Nations). This conference report summarizes select talks given at MHM9 highlighting recent research advances, as well as talks regarding the historic and ongoing impact of TB and other infectious diseases on Native American Nations, including those in Southwestern Alaska where the regional TB incidence rate is among the highest in the Western hemisphere. [ABSTRACT FROM AUTHOR]

This paper describes a technique to magnify the scattering of a wave at a defect by using the natural behavior of a structure. The fundamental physical principle of the detection strategy as well as the way to exploit this principle for detecting defects are explained. The influence of the parameters defect location, defect size and natural frequency selected, is investigated in a numerical example considering a 1mm thick A3 Aluminum plate. The proposed defect detection strategy is based on the measurement of frequency response functions at a very limited number of response locations and is therefore very easy to apply. Furthermore, an experimental validation of the detectability of a square 4mm through thickness defect is performed. Due to its simplicity and the low number of sensors necessary, the strategy explained in this paper allows the detection of a defect very rapidly. [ABSTRACT FROM AUTHOR]

Summary Objective Musical theater performers are a special group of elite vocal performers with a high vocal load as they combine singing, acting, and physical performance. As they are absolutely depending on their voice quality and vocal capacities for their studies and their future profession, an optimal voice production is very important. The purpose of this study was to determine the voice quality of musical theater students. The voice quality of seven students was then reevaluated 1 year after the first assessment. Study design Observational study. Methods Thirty-one musical students (7 men and 24 women) with a mean age of 20 years participated in the study. To determine the voice quality, objective (aerodynamic measurements, voice range profile, acoustic analysis, and Dysphonia Severity Index) and subjective (videolaryngostroboscopy, Voice Handicap Indexes, and questionnaires regarding voice symptoms and risk factors) voice measurements were performed. Results The median Dysphonia Severity Index in male and female musical students was respectively 5.3 and 5.7, both corresponding with an overall good voice quality. The questionnaires revealed the presence of vocal fatigue, dryness of the throat, vocal tract discomfort, and harmful vocal habits in the majority of students. In 45% of the subjects, videolaryngostroboscopic evaluation of the vocal folds showed an organic lesion. The majority of these lesions are inflammatory lesions (26%). In 68% of the subjects, a certain degree of supraglottic constriction was observed. Conclusion Despite the overall good voice quality, videolaryngostroboscopy showed a high presence of vocal fold lesions and supraglottic constriction during phonation. [ABSTRACT FROM AUTHOR]

Abursanema quadrilineatum n. sp. was described both morphologically from light microscopy, scanning electron microscopy and transmission electron microscopy and molecularly based on 18S and 28S rRNA. The mycetophagous females were recovered from the old mushroom fruiting body of bracket fungus Trametes sp. growing on decaying wood. The new species is unique in Abursanema , indicated by the presence of four lateral lines. The secondary structures of the D2 and D3 domain of 28S rRNA were predicted for the new species and a general model for the superfamily Sphaerularioidea was built for comparative analysis. The ultrastructure of the cuticle, sperm cells and oocytes was examined and cuticle layers were defined. Needle-shaped crystals were recovered in mycetophagous female intestines and spermatheca, and chemical tests revealed that they are not composed of calcium oxalate or proteins. [ABSTRACT FROM AUTHOR]

This viewpoint paper presents a reaction to the article by Brandt et al. (2016) . It highlights the complexities inherent to the attribution of deforestation impacts to policy interventions when using remote-sensing data. This critique argues that in the context of the Congo a suite of factors (i.e., population density in particular) other than those considered by Brandt et al. (e.g., type of forest, distance from roads and markets) play essential roles in determining the fates of forests. It also contends that care is needed when making decisions regarding which units will be included in the comparison group so that contextual factors and on-the-ground information are properly considered (e.g., when logging operations are inactive or when a concession is used for ‘conservation’ purposes). Finally, it proposes that a focus on an analysis of deforestation rates for a given level of timber production might be a metric that more accurately represents one aspect of the consequences of forest management, which should also consider the appraisal of trade-offs associated with a larger set of social, financial and ecological objectives. [ABSTRACT FROM AUTHOR]

Summary Objectives The purpose of this study was to determine how use of the vocal facilitating technique, chewing, affected the phonation of speech-language pathology (SLP) students. Study Design A pretest-posttest randomized control group design was used. Methods Twenty-seven healthy female SLP students were randomly assigned into either an experimental group or a control group. The experimental group practiced chewing exercises across 18 weeks, whereas the control group received no vocal facilitating techniques. Both groups completed pre- and post- objective voice assessment measures (aerodynamic measurement, acoustic analysis, voice range profile, and Dysphonia Severity Index). Differences between pre- and post-data were compared between the experimental and control group using an independent sample t test. Results Compared to the control group, chewing resulted in a significant decrease in jitter and noise-to-harmonic ratio (NHR), a significant increase in fundamental frequency ( f o ), a significant expansion of the voice range profile, and a significant increase in Dysphonia Severity Index (DSI). Shimmer and maximum phonation time (MPT) were not significantly different between groups. Conclusions The results of this pilot study suggest that the vocal facilitating technique, chewing, may improve objective vocal measures in healthy female SLP students. [ABSTRACT FROM AUTHOR]

Background Enterococcal bloodstream infections (EBSIs) are frequently polymicrobial but scant data describe the outcomes and risk factors of polymicrobial EBSI. This study describes the outcomes and risk factors of polymicrobial versus monomicrobial EBSI. Methods In this single-center, retrospective, matched cohort study, patients with polymicrobial EBSI were matched 1:1 to patients with monomicrobial EBSI by age ± 10 years, EBSI source, Pitt bacteremia score, and enterococcal species. Conditional logistic regression was performed to determine independent predictors of 30-day mortality and polymicrobial EBSI. Results In 142 matched pairs, 30-day mortality was 18.3% versus 21.1% ( P  = .551) in monomicrobial and polymicrobial EBSI, respectively. In multivariable analysis, recent chemotherapy/radiation (adjusted odds ratio [OR], 4.799; 95% confidence interval [CI], 1.814-12.696), chronic renal disease (aOR, 2.310; 95% CI, 1.176-4.539), and Pitt bacteremia score (aOR, 1.399; 95% CI, 1.147-1.706) were associated with 30-day mortality. Recent chemotherapy/radiation (aOR, 2.770; 95% CI, 1.016-7.551), and recent antibiotic exposure (aOR, 1.892; 95% CI, 1.157-3.092) were positively associated with polymicrobial EBSI, whereas chronic hemodialysis was negatively associated (aOR, 0.496; 95% CI, 0.29-81). Conclusions Overall, polymicrobial EBSI were not independently associated with mortality. Risk factors for, and the clinical implications of, polymicrobial EBSI should be further studied to inform clinical management and improve outcomes. [ABSTRACT FROM AUTHOR]

Summary Postural rehabilitation often plays an important role in the management of non-specific low back pain. While cervical and lumbar correlations have been demonstrated previously, the different role of the pelvis and the thoracic spine for postural control in sitting and standing remains unclear. The aim of this study was to investigate postural correlations between all spinal regions in standing and sitting. Based on digital photographs eight postural angles were analyzed in 99 young healthy persons. Pearson correlations between different postural angles were calculated. In sitting pelvic tilt demonstrated mostly medium correlations with five out of seven other postural angles, compared to three in standing. In standing trunk angle showed five out of seven mostly medium correlations with other regions compared to four out of seven in usual sitting. The low and different correlations suggest a large between-subject variability in sagittal spinal posture, without the existence of any optimal sagittal posture. [ABSTRACT FROM AUTHOR]

Air curtain assisted range hoods are very customary in large industrial kitchens. They allow to increase the capture efficiency of the range hood while lowering the net exhaust flow rate. For applications in residential settings, there is a lack of data on the performance of air curtain assisted range hoods, as well as a lack of information on the required settings and boundary conditions to come to the successful application of air curtain assisted range hoods. In this paper we present the results from an experimental test campaign in which we investigated the capture efficiency of a residential air curtain assisted range hood in comparison with a regular range hood, as well as the sensitivity of the capture efficiency to boundary conditions such as net exhaust flow rate, height above the range, enclosure etc. The results show that air curtain assisted range hoods are more efficient at lower flow rates, especially in non-enclosed settings, confirming the performance known from industrial kitchens, but are sensitive to higher mounting and on-going cooking activities. [ABSTRACT FROM AUTHOR]

[Display omitted] • Chicxulub impact cratering processes documented by Fe, Cu, and Zn isotope systematics. • Primary isotopic signatures preserved despite hydrothermal alteration within the crater. • Fe and Cu isotope ratios imply target rock mixing and secondary mineral formation. • Impact volatilization present based on Zn isotope ratios of selected samples. • Impact condensation possibly recorded within the upper impact melt rock unit. This work presents isotopic data for the non-traditional isotope systems Fe, Cu, and Zn on a set of Chicxulub impactites and target lithologies with the aim of better documenting the dynamic processes taking place during hypervelocity impact events, as well as those affecting impact structures during the post-impact phase. The focus lies on material from the recent IODP-ICDP Expedition 364 Hole M0077A drill core obtained from the offshore Chicxulub peak ring. Two ejecta blanket samples from the UNAM 5 and 7 cores were used to compare the crater lithologies with those outside of the impact structure. The datasets of bulk Fe, Cu, and Zn isotope ratios are coupled with petrographic observations and bulk major and trace element compositions to disentangle equilibrium isotope fractionation effects from kinetic processes. The observed Fe and Cu isotopic signatures, with δ 56/54Fe ranging from −0.95‰ to 0.58‰ and δ 65/63Cu from −0.73‰ to 0.14‰, mostly reflect felsic, mafic, and carbonate target lithology mixing and secondary sulfide mineral formation, the latter associated to the extensive and long-lived (>105 years) hydrothermal system within Chicxulub structure. On the other hand, the stable Zn isotope ratios provide evidence for volatility-governed isotopic fractionation. The heavier Zn isotopic compositions observed for the uppermost part of the impactite sequence and a metamorphic clast (δ 66/64Zn of up to 0.80‰ and 0.87‰, respectively) relative to most basement lithologies and impact melt rock units indicate partial vaporization of Zn, comparable to what has been observed for Cretaceous-Paleogene boundary layer sediments around the world, as well as for tektites from various strewn fields. In contrast to previous work, our data indicate that an isotopically light Zn reservoir (δ 66/64Zn down to −0.49‰), of which the existence has previously been suggested based on mass balance considerations, may reside within the upper impact melt rock (UIM) unit. This observation is restricted to a few UIM samples only and cannot be extended to other target or impact melt rock units. Light isotopic signatures of moderately volatile elements in tektites and microtektites have previously been linked to (back-)condensation under distinct kinetic regimes. Although some of the signatures observed may have been partially overprinted during post-impact processes, our bulk data confirm impact volatilization and condensation of Zn, which may be even more pronounced at the microscale, with variable degrees of mixing between isotopically distinct reservoirs, not only at proximal to distal ejecta sites, but also within the lithologies associated with the Chicxulub impact crater. [ABSTRACT FROM AUTHOR]

Abstract: The rapid evolution of information and positioning technologies, and their increasing adoption in tourism management practices allows for new and challenging research avenues. This paper presents an empirical case study on the mining of association rules in tourist attraction visits, registered for 15 days by the Bluetooth tracking methodology. This way, this paper aims to be a methodological contribution to the field of spatiotemporal tourism behavior research by demonstrating the potential of ad-hoc sensing networks in the non-participatory measurement of small-scale movements. An extensive filtering procedure is followed by an exploratory analysis, analyzing the discovered associations for different visitor segments and additionally visualizing them in ‘visit pattern maps’. Despite the limited duration of the tracking period, we were able to discover interesting associations and further identified a tendency of visitors to rarely combine visits in the center with visits outside of the city center. We conclude by discussing both the potential of the employed methodology as well as its further issues. [Copyright &y& Elsevier]

Abstract: The study of the hygrothermal parameters and performance of permeable materials is being expanded; however, there is a lack of guidelines or regulation regarding the level of liquid water migrations associated with existing materials. Even if some existing recommendations demand the installation of materials that are increasingly permeable to vapour, the liquid water absorption coefficient is often neglected. This study analyses the influence of six material parameters, such as the liquid absorption coefficient and vapour diffusion resistance, on the hygrothermal behaviour of an existing brick wall insulated on the inside surface with a Lime–Hemp plaster. A specific methodology is developed combining hygrothermal simulations, sensitivity analysis and an experimental planning method. This reproducible methodology allows recommendations to be proposed to help designers choose an appropriate combination of material parameters. The paper demonstrates that the water liquid absorption coefficients of brick and of insulation have a greater influence than the vapour diffusion resistance of those materials in the studied cases. Water liquid absorption coefficient should thus be one of the parameters systematically considered in the hygrothermal analyses of wall components. [Copyright &y& Elsevier]

Background An electronic decision support programme was developed within the intensive care unit (ICU) that provides an overview of all infection-related patient data, and allows ICU physicians to add clinical information during patient rounds, resulting in prospective compilation of a database. Aim To assess the validity of computer-assisted surveillance (CAS) of ICU-acquired infection performed by analysis of this database. Methods CAS was compared with prospective paper-based surveillance (PBS) for ICU-acquired respiratory tract infection (RTI), bloodstream infection (BSI) and urinary tract infection (UTI) over four months at a 36-bed medical and surgical ICU. An independent panel reviewed the data in the case of discrepancy between CAS and PBS. Findings PBS identified 89 ICU-acquired infections (13 BSI, 18 UTI, 58 RTI) and CAS identified 90 ICU-acquired infections (14 BSI, 17 UTI, 59 RTI) in 876 ICU admissions. There was agreement between CAS and PBS on 13 BSI (100 %), 14 UTI (77.8 %) and 42 RTI (72.4 %). Overall, there was agreement on 69 infections (77.5%), resulting in a kappa score of 0.74. Discrepancy between PBS and CAS was the result of capture error in 11 and 14 infections, respectively. Interobserver disagreement on probability (13 RTI) and focus (two RTI, one UTI) occurred for 16 episodes. The time required to collect information using CAS is less than 30% of the time required when using PBS. Conclusion CAS for ICU-acquired infection by analysis of a database built through daily workflow is a feasible surveillance method and has good agreement with PBS. Discrepancy between CAS and PBS is largely due to interobserver variability. [ABSTRACT FROM AUTHOR]

Abstract: This paper discusses the need for a shift towards more Foresight-based inclusive innovation processes and introduces the concept of “Innovation Foresight” (IF) in this respect. IF represents an approach for bringing the future into holistic innovation processes, in which users and other stakeholders are systematically involved to detect future opportunities and risks. This could allow for a better integration of inclusive, long-term visions in decision-making and strategic thinking in the context of innovation. To be effective and enable mutual learning, the IF process calls for future-oriented, continuous interaction with current/anticipated users and a better integration of methods and approaches from different fields, including Foresight, user/market research and human-centred product design. This paper discusses two empirical studies that closely involved users in the exploration, imagination and creation of future TV experiences. Study 1 aimed to identify users’ specific (future) needs and possible Lead User ideas concerning digital TV (DTV) in Flanders through an online survey (N =11.802 digital TV users). 13 unique ideas representing important unfulfilled needs were identified and evaluated. Study 2, which focused on ‘Future TV experiences’, consisted of a multi-method research approach in three phases, resulting in six persona profiles, that help to provide an understanding of users’ daily practices and futures aspirations. It is argued that a better introduction of future anticipation in inclusive innovation processes could enhance the input of users in innovation and contribute to the detection of potential user/societal needs and possible unexpected forms of use. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the potential therapeutic effect of intratendinous injection of platelet-rich plasma (PRP) under ultrasound (US) guidance to treat tendon tears and tendinosis in a pilot study with long-term follow-up. Materials and Methods: The study included 408 consecutive patients referred for treatment by PRP injection of tendinopathy in the upper (medial and lateral epicondylar tendons) and the lower (patellar, Achilles, hamstring and adductor longus, and peroneal tendons) limb who received a single intratendinous injection of PRP under US guidance. Clinical and US data were retrospectively collected for each anatomic compartment for upper and lower limbs before treatment (baseline) and 6 weeks after treatment. Late clinical data without US were collected until 32 months after the procedure (mean, 20.2 months). The McNemar test and regression model were used to compare clinical and US data. Results: QuickDASH score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and residual US size of lesions were significantly lower after intratendinous injection of PRP under US guidance at 6 weeks and during long-term follow-up compared with baseline (P < .001 in upper and lower limb) independent of age, gender, and type of tendinopathy (P > .29). No clinical complication was reported during follow-up. Conclusions: Intratendinous injection of PRP under US guidance appears to allow rapid tendon healing and is well tolerated. [Copyright &y& Elsevier]

Highlights: [•] A GC method for quantification of pinitol in D. adscendens was developed. [•] Different internal standards and derivatization methods were evaluated. [•] The final method was validated. [•] The calibration model was linear, the precision and accuracy were acceptable. [Copyright &y& Elsevier]

The effects of process parameters: pressure (200 – 400 bar), temperature (313 – 333 K), and flow rate (0.11 – 0.27 kg/h) on the efficiency of extraction process of Argan oil by supercritical CO 2 were investigated using response surface methodology and mathematical modelling (Sovová's mathematical model). The fastest extraction kinetics corresponding to the optimal operating conditions were obtained at 400 bar, 333 K at a CO 2 flow rate of 0.11 kg corresponding to a residence time of about 8.8 min. A tocopherol rich oil can be obtained at the beginning of the extraction experiment. [Display omitted] • The optimal operating conditions for the extraction of argan oil using supercritical CO2 were reported. • The effects of pressure, temperature and flow rate on oil solubility and extraction efficiency were investigated. • The effects of SC-CO2 time residence in the extraction on the extraction kinetic of argan oil were investigated. • Sovova's BIC mathematical model was applied for a better understanding of the mechanism of extraction kinetics. • The effect of pressure on the oil composition (fraction of fatty acid) was determined. [ABSTRACT FROM AUTHOR]

Background: Patients with prior coronary artery bypass graft surgery (CABG) who present with an acute coronary syndrome have a high risk for recurrent events. Whether intensive antiplatelet therapy with ticagrelor might be beneficial compared with clopidogrel is unknown. In this substudy of the PLATO trial, we studied the effects of randomized treatment dependent on history of CABG. Methods: Patients participating in PLATO were classified according to whether they had undergone prior CABG. The trial's primary and secondary end points were compared using Cox proportional hazards regression. Results: Of the 18,613 study patients, 1,133 (6.1%) had prior CABG. Prior-CABG patients had more high-risk characteristics at study entry and a 2-fold increase in clinical events during follow-up, but less major bleeding. The primary end point (composite of cardiovascular death, myocardial infarction, and stroke) was reduced to a similar extent by ticagrelor among patients with (19.6% vs 21.4%; adjusted hazard ratio [HR], 0.91 [0.67, 1.24]) and without (9.2% vs 11.0%; adjusted HR, 0.86 [0.77, 0.96]; P interaction = .73) prior CABG. Major bleeding was similar with ticagrelor versus clopidogrel among patients with (8.1% vs 8.7%; adjusted HR, 0.89 [0.55, 1.47]) and without (11.8% vs 11.4%; HR, 1.08 [0.98, 1.20]; P interaction = .46) prior CABG. Conclusions: Prior-CABG patients presenting with acute coronary syndrome are a high-risk cohort for death and recurrent cardiovascular events but have a lower risk for major bleeding. Similar to the results in no-prior-CABG patients, ticagrelor was associated with a reduction in ischemic events without an increase in major bleeding. [Copyright &y& Elsevier]

Summary: Objectives: Muscle tension dysphonia (MTD) is the pathological condition in which an excessive tension of the (para)laryngeal musculature leads to a disturbed voice. Surface electromyography (sEMG) was used to investigate differences in extralaryngeal muscles’ tension in patients with MTD compared with normal speakers. sEMG was examined as a diagnostic tool to differentiate between patients with MTD and controls. Methods: Eighteen patients with MTD and 44 normal speakers were included in the study. All subjects were evaluated with videostroboscopy, voice assessment protocol, and sEMG. sEMG was performed on three locations of the anterior neck. Measurements were taken during silence, phonation tasks, and while reading, with comparisons made between both study groups. Results: Patients with MTD did not express higher levels of sEMG during rest, phonation, or reading compared with normal speakers. There were no significant differences in sEMG values between males and females in both study groups. Conclusion: sEMG was not able to detect an increase in muscle tension in patients with MTD. The results of this study do not support the use of sEMG as a diagnostic tool for distinguishing patients with and without MTD. Clinical examination with laryngeal palpation, videostroboscopy, and dysphonia severity index remain the key investigations. [Copyright &y& Elsevier]

Summary: Objective: The purpose of this study is to determine objective vocal quality, vocal characteristics, and vocal habits in future speech language pathology (SLP) students and to evaluate the possible impact of a provided vocal counseling procedure. A comparison of vocal data was done in SLP students who had and who had not undergone vocal counseling procedure. It is hypothesized that counseling results in good vocal quality, adequate vocal performance, and appropriate vocal hygiene. Study Design: Randomized controlled study design. Methods: To determine the vocal quality, questionnaires (Voice Handicap Index [VHI]), subjective (videostroboscopic and perceptual evaluations), and instrumental assessment techniques (aerodynamic, vocal range, acoustic measurements, Dysphonia Severity Index [DSI]) were used. Identical voice assessments were made in 71 students who followed and have not (n=83) followed the vocal counseling procedure. Results: The VHI showed the absence of a psychosocial impact of the vocal quality. Thirty percentage of the subjects mentioned hoarseness as the most common vocal complain. Videostroboscopic evaluations revealed normal vocal anatomy and physiology. A significant difference regarding the DSI value was found between the students with (+3.3, 83%) and without (+1.8, 68%) a followed voice counseling procedure. Conclusion: This vocal counseling procedure is added as a standard procedure when future students gain information about the SLP master program. To what extent the presence and content of the vocal education strategy can influence the choice of the profession as an SLP is subject for further research. [ABSTRACT FROM AUTHOR]

Abstract: The Fischer Tropsch (FT) synthesis is a complex polymerization reaction characterized by competing intermediates reaction steps. The various termination steps may result in the formation of different product classes, such as olefins, paraffins, alcohols, etc. While high synthesis gas conversion is important; a high selectivity is much desirable, which may result in.improved economics. This mechanistic study further elaborates on the elementary reaction steps for the formation of product compounds in the Fischer-Tropsch synthesis. The effect of space velocity on the products distribution, particularly on the formation of oxygen containing organic product compounds was investigated. The reactions were carried out at industrially relevant conditions on Fe-based catalyst promoted with Cu, K and alumina. The resulting catalyst precursor was characterized using TPR, XRD, BET and SEM/EDX. The alcohol/hydrocarbon ratio remains fairly constant at very high space velocity (i.e. low conversion) where secondary reactions become insignificant. This implied primary formation of alcohols in the Fischer-Tropsch synthesis. [Copyright &y& Elsevier]

Summary: Objectives: Teachers are at increased risk for developing voice disorders. Occupational risk factors have been extensively examined; however, little attention has been paid to the consequences of the vocal complaints. The objective of this study was to investigate the knowledge that teachers have about vocal care, treatment-seeking behavior, and voice-related absenteeism. Methods: The study group comprised 994 teachers and 290 controls whose jobs did not involve vocal effort. All participants completed a questionnaire inquiring about vocal complaints, treatment-seeking behavior, voice-related absenteeism, and knowledge about vocal care. Comparisons were made between teachers with and without vocal complaints and with the control group. Results: Teachers reported significantly more voice problems than the control population (51.2% vs 27.4%) (χ 2 =50.45, df=1, P <0.001). Female teachers reported significantly higher levels of voice disorders than their male colleagues (38% vs 13.2%, χ 2 =22.34, df=1, P <0.001). Teachers (25.4%) sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. Female teachers were significantly more likely to seek medical help (χ 2 =7.24, df=1, P =0.007) and to stay at home (χ 2 =7.10, df=1, P =0.008) in comparison with their male colleagues. Only 13.5% of all teachers received information during their education. Conclusions: Voice disorders have an impact on teachers'' personal and professional life and imply a major financial burden for society. A substantial number of teachers needed medical help and was obligated to stay at home because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user. [Copyright &y& Elsevier]

Summary: Aging influences the laryngeal anatomy and physiology, leading to altered vocal quality. In middle-aged women, the voice is affected by a combination of aging and menopausal transition. However, in many studies about vocal aging, the menopausal transition is not taken into account. The purpose of this study was to measure and describe the effect of aging on the vocal characteristics by comparing young women (between 20 and 28 years) and middle-aged premenopausal women (between 45 and 52 years). To determine the vocal characteristics in both groups, objective (aerodynamic measurements, vocal performance measurements, acoustic analysis, and a determination of the Dysphonia Severity Index) and subjective assessment techniques (perceptual evaluation, videostroboscopic evaluation, and Voice Handicap Index) were used. The middle-aged premenopausal women showed a smaller frequency and intensity range, a lower habitual fundamental frequency, and a higher soft phonation index compared with the young women. The results of this study are important when studying the voices of middle-aged women. Vocal characteristics of middle-aged women differ from young women, and these changes cannot only be because of hormonal changes during the menopause. [Copyright &y& Elsevier]

Summary: Objective: Muscle tension dysphonia (MTD) is a clinical and diagnostic term describing a spectrum of disturbed vocal fold behavior caused by increased tension of the (para)laryngeal musculature. Recent knowledge introduced MTD as a bridge between functional and organic disorders. This review addresses the causal and contributing factors of MTD and evaluates the different treatment options. Methods: We searched MEDLINE (Pubmed, 1950–2009) and CENTRAL (The Cochrane Library, Issue 2, 2009). Studies were included if they reviewed the classification of functional dysphonia or the pathophysiology of MTD. Etiology and pathophysiology of MTD and circumlaryngeal manual therapy (CMT) were obligatory based on reviews and prospective cohort studies because randomized controlled trials (RCTs) are nonexisting. Concerning the treatment options of voice therapy and vocal hygiene, selection was based on RCTs and systematic reviews. Results: Etiological factors can be categorized into three new subgroups: (1) psychological and/or personality factors, (2) vocal misuse and abuse, and (3) compensation for underlying disease. The effective treatment options for MTD are (1) indirect therapy: vocal hygiene and patient education; (2) direct therapy: voice therapy and CMT; (3) medical treatment; and (4) surgery for secondary organic lesions. Conclusions: MTD is the pathological condition in which an excessive tension of the (para)laryngeal musculature, caused by a diverse number of etiological factors, leads to a disturbed voice. Etiological factors range from psychological/personality disorders and vocal misuse/abuse to compensatory vocal habits in case of laryngopharyngeal reflux, upper airway infections, and organic lesions. MTD needs to be approached in a multidisciplinary setting where close cooperation between a laryngologist and a speech language pathologist is possible. [Copyright &y& Elsevier]

Summary: The purpose of the present cross-sectional study was to determine the objective vocal quality and the vocal characteristics (vocal risk factors, vocal and corporal complaints) in 143 female student teachers during the 3 years of study. The objective vocal quality was measured by means of the Dysphonia Severity Index (DSI). Perceptual voice assessment, the Voice Handicap Index, questionnaires addressing vocal risks, and vocal and corporal complaints during and/or after voice usage were performed. Student teachers have a normal perceptual and objective vocal quality corresponding with a DSI% of 76. The analysis of variance revealed a significant improvement of the vocal quality between the first and the third year of study. No psychosocial handicapping effect of the voice was observed, though there are some vocal complaints and almost all student teachers reported the presence of corporal pain during and/or after speaking. Especially sore throat and headache were mentioned as the most present corporal pain symptoms. Due to the decreased awareness and the multifactorial genesis of the potential vocal risk factors, the student teachers are at risk for developing an occupational dysphonia during their teaching career. Because teaching is a high-risk profession for the development of voice problems, the incorporation of a direct vocal training technique to increase vocal endurance during teaching together with a vocal hygiene program, dietetics, and a stress management training program during the 3 years of study is needed to prevent occupational dysphonia. [Copyright &y& Elsevier]