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A conservative hemoglobin transfusion threshold is noninferior to a liberal threshold in cardiac surgery. However, red blood cell (RBC) transfusion remains common during cardiac surgery. The authors' single-center, retrospective study aimed to decrease RBC transfusions for hemoglobin >7.5 g/dL in nonemergent cardiovascular surgeries utilizing cardiopulmonary bypass (CPB), by educating the anesthesiology and surgical staff on the benefits of a conservative threshold for transfusions, and incorporating the discussion and routine use of blood conservation methods for all nonemergent cardiac surgeries. This was a single-center, retrospective study that included all nonemergent coronary artery bypass grafting and single-valve cases utilizing CPB from January 2018 to December 2021 before and after the intervention in July 2019. The data involved a single community hospital. A total of 417 patients were included in the study. The authors adopted a conservative threshold for blood transfusion and implemented a collaborative multidisciplinary approach to blood conservation. Baseline patient characteristics were summarized, and the incidence of RBC transfusion before and after the intervention on July 26, 2019, were compared by Wilcoxon rank sum and chi-square tests. Multivariate logistic regression was used. The intervention was significantly associated with reduced RBC transfusion rate after adjusting for confounding variables (p < 0.05). The odds of receiving an RBC transfusion among patients after the intervention was 0.615 times the odds among patients before intervention (95% CI: 0.3913-0.9663). The authors' goal was to improve patient outcomes and the quality of perioperative care during cardiac surgery. By implementing a protocol and educating anesthesiologists, surgeons, and perfusionists, they successfully decreased the incidence of RBC transfusion above a hemoglobin of 7.5 g/dL. [ABSTRACT FROM AUTHOR]

Lateral dog ear after mastectomy in overweight or large breasted patients is a source for patient discomfort and is aesthetically unpleasing. Although many different techniques have been proposed, none of them have emerged as standard. In 2012, the authors published their mastectomy technique based on an inverted L-scar incision and closure with a lateral skin flap advanced supero-medially onto the chest wall. Authors sought to report their experience with this technique in patients with wide or large breasts operated with mastectomy without immediate breast reconstruction. As a refinement to their initial technique, they added lipoaspiration to the lateral chest wall. A retrospective study identified 43 patients operated on using the L incision and lipoaspiration from January 2015 to January 2021. Patient and tumor characteristics, operative details, post-operative results, and complications were recorded. Patients were followed-up and assessed for arm motion restriction, lymphedema, and recurrence. The mean age was 68 years; the mean BMI was 29 kg/m 2. The mean follow-up was 32 months. The mean weight of the mastectomy specimen was 1009 g and the mean aspirated volume in the lateral chest wall was 450 mL. One patient had a hematoma, four patients had seroma, and one patient developed a minor wound dehiscence. No skin necrosis or arm movement restriction was observed. Two patients developed mild lymphedema. Three patients underwent delayed breast reconstruction. The proposed technique is a safe and effective method to avoid lateral dog deformity after mastectomy, achieving both functional and cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite rigorous disinfection and fumigation, healthcare-associated infection (HAI) remains a significant concern in healthcare settings. We have developed a novel airborne-microbicidal technology 'ZeBox' which clears >99.999% of airborne microbial load under controlled laboratory conditions.Aim: To evaluate the clinical performance of ZeBox in reducing airborne and surface microbial load.Methods: The study was conducted in single-bed and multi-bed intensive care units (ICUs) of two hospitals. Airborne and surface microbial loads were sampled pre and post deployment of ZeBox at pre-determined sites. Statistical significance of the reduction was determined using the Mann-Whitney U-test.Findings: ZeBox brought statistically significant reduction of both airborne and surface bacterial and fungal load. In both hospital ICUs, airborne and surface bacterial load decreased by 90% and 75% on average respectively, providing a low bioburden zone of 10-15 feet diameter around the unit. The reduced microbial level was maintained during ZeBox's operation over several weeks. Most clinical bacterial isolates recovered from one of the hospitals were antibiotic resistant, highlighting ZeBox's ability to eliminate antimicrobial-resistant bacteria among others.Conclusion: ZeBox significantly reduces airborne and surface microbial burden in clinical settings. It thereby serves an unmet need for reducing the incidence of HAI. [ABSTRACT FROM AUTHOR]

A comparison when made between the quantitative importance of education policy, labor market rigidity and product market regulation, other policies more commonly suggested to be responsible for US-Europe differences. A major role to education policy in explaining US-Europe growth differences is assigned by a 'decomposition' exercise using a calibrated version of a model.

Breast implants are widely used in reconstruction after breast cancer. Infection after implant reconstruction is a major complication, with rates ranging from 5 to 30%. This rate is less for pure cosmetic augmentation. Historically, infection of an implant mandated implant removal for sepsis control. An alternative is to attempt to salvage the infected implant. This path can be a long one, requiring surgery for washouts and prolonged antibiotic therapy. This article documents our experience of infected implant salvage over the last 13 years. We conducted a retrospective analysis of all patients who developed a breast implant infection between January 2005 and January 2018. All patients had both clinical signs of infection and a positive bacteriological sample. Patients were divided into two groups: upfront medical therapy (including those requiring secondary surgical salvage) and primary surgery. The salvage procedure was defined as successful when the implant was still in place three months after the initial reconstruction. Eighty patients were included: 77 in the medical group and 3 in the surgical group. Overall, implant salvage was achieved in 88.8% of women (n=71). Of these, 73.8% (n=59) underwent medical treatment alone and 15% (n=12) underwent medical treatment followed by surgical management. The main causative organism was staphylococcus in 81.2%. When the infection was caused by a coagulase-negative staphylococcus, the rate of success was 98% (p<0.003). This case series reports that salvage of an infected breast implant was achievable in up to 90% of women presenting with a documented infection, the majority requiring antibiotic management only. Early intervention is central to success. [ABSTRACT FROM AUTHOR]

Breast cancer in women with cosmetic breast implants is increasingly common. Over the past decade, there has been a push for mastectomy and reconstruction in these patients, based on a fear of poor aesthetic results from small breast volume, and radiation-induced capsular contracture. At the Paris Breast Centre, augmented women routinely undergo lumpectomy with whole-breast irradiation (BCT). A consecutive cohort of 50 augmented women, who had attempted BCT for early breast cancer at our institution between 2003 and 2018, were retrospectively identified. Post-treatment complications, oncologic outcomes, capsular contracture rates, long-term cosmetic outcomes, and patient-reported outcomes were evaluated. The median follow-up was 51 months. Margins were involved in 7 women (14%); 4 of whom underwent successful re-excision, and 3 had a mastectomy, for an early mastectomy rate of 6%. There were no early complications, nor cases of early implant loss. Long-term aesthetic results were evaluated using our 5-point scale: An excellent (5), or good (4) result was obtained in 68%. Significant capsular contracture (Baker grade 3 or 4) developed in 34%, of which, 5 women underwent capsulotomy and fat grafting; 4 of 5 downstaging their Baker grade. The estimated 5-year local recurrence rate was 2.3%. Ninety-five percent of participants would recommend BCT to augmented women. BCT is feasible and safe in augmented women with good long-term aesthetic results, and should be considered to avoid unnecessary mastectomy. [ABSTRACT FROM AUTHOR]

The Notch signaling pathway, which is highly conserved from sea urchins to humans, plays an important role in cell-differentiation, survival, proliferation, stem-cell renewal, and determining cell fate during development and morphogenesis. It is well established that signaling pathways are dysregulated in a wide-range of diseases, including human malignancies. Studies suggest that the dysregulation of the Notch pathway contributes to carcinogenesis, cancer stem cell renewal, angiogenesis, and chemo-resistance. Elevated levels of Notch receptors and ligands have been associated with cancer-progression and poor survival. Furthermore, the Notch signaling pathway regulates the transcriptional activity of key target genes through crosstalk with several other signaling pathways. Indeed, increasing evidence suggests that the Notch signaling pathway may serve as a therapeutic target for the treatment of several cancers, including breast cancer. Researchers have demonstrated the anti-tumor properties of Notch inhibitors in various cancer types. Currently, Notch inhibitors are being evaluated for anticancer efficacy in a number of clinical-trials. However, because there are multiple Notch receptors that can exhibit either oncogenic or tumor-suppressing roles in various cells, it is important that the Notch inhibitors are specific to particular receptors that are tumorigenic in nature. This review critically evaluates existing Notch inhibitory drugs and strategies and summarizes the previous discoveries, current understandings, and recent developments in support of Notch receptors as therapeutic targets in breast cancer. [ABSTRACT FROM AUTHOR]

Purpose: To provide data on the prevalence of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and parent reported behaviour difficulties in young children with epilepsy, and to compare results with children with neurodisability (neurodevelopmental/neurological difficulties) without epilepsy.Method: Children with epilepsy (1-7 years, n = 48) and children with neurodisability (1-7 years, n = 48) matched for gender, chronological and developmental age underwent psychological assessment. Parents completed measures of behaviour including the Strengths and Difficulties Questionnaire (SDQ). DSM-5 diagnoses of ASD and ADHD were made at consensus case conferences. Factors associated with child behaviour were analysed using linear regression.Results: Of the children with epilepsy, 18% met ASD criteria and 40% met ADHD criteria (corresponding figures in the non-epilepsy group were 41% and 27%). A large proportion (76%-78%) in both groups scored in the at-risk range on the SDQ and frequently had difficulties across multiple behavioural domains. Children with epilepsy had more concerns expressed regarding attention and mood. None of the epilepsy factors were significantly associated with scores on the behavioural measures.Significance: Young children with epilepsy had a very high level of parent reported behavioural difficulties and a high risk for ADHD and ASD highlighting the need for comprehensive multidisciplinary assessment. Behavioural concerns were not greater than for other children with non-epilepsy related neurodisability with the exception of attention and mood. Epilepsy related factors were not associated with child behaviour, suggesting that seizures per se do not confer a unique risk for behavioural difficulties. [ABSTRACT FROM AUTHOR]

Highlights • Old world bluestem (OWB) grass contained measurable amounts of essential oils. • Acorenone-B was present in the greatest concentration over three years. • Presence of camphene, limonene, and naphthalene may be associated with repellency of red imported fire ants. Abstract Bothriochloa spp. include aromatic grasses that produce essential oils. Some of these grasses are reported to repel economically important insects. Leaves, stems, and seedheads of 'WW-B.Dahl' old world bluestem [ Bothriochloa bladhii (Retz) S.T. Blake] were sampled during 3 years. Quantitative analysis by GC and GC–MS methods revealed a total of 172 compounds from methylation method, and 105 compounds from steam distillation method. Acorenone-B [spiro[4.5]dec-6-en-8-one, 1,7-dimethyl-4-(1-methylethyl)-] was in greatest concentration in both methods; however, this compound was detected on only one date (12 August) out of three collection dates extracted by steam distillation. Twenty-two compounds were detected by simple solvent extraction, in which acorenone-B was in greatest concentration in seedheads and least in stems. Diethylhexyl adipate was in highest concentration in stems and least in seedheads among the oils extracted by simple solvent. Camphene and limonene were present in the samples that contained seedheads. Naphthalene, a known insect deterrent, was detected in oils extracted from all methods and in all plant parts. Old world bluestem grass contained measurable amounts of essential oils that may be associated with previously observed repellency of red imported fire ants (Solenopsis invicta Buren). [ABSTRACT FROM AUTHOR]

Abstract Research works are ongoing in mixing the biologically synthesized oil with the diesel for reducing the effect of global warming and climate change. From the review study, it is noted that the blended biodiesels require more assert about their practical viability. So, the non-edible Tamanu oil is synthesized and it is blended with diesel and its emission characteristics, engine performance and combustion characteristics are studied in our previous work. This paper attempts to model the diesel engine fueled with tamanu oil biodiesel blend. The proposed model exploits the context of neural network and the firefly algorithm is used to train it. After analyzing the various characteristics of the diesel engine, the acquired data is subjected to a proposed FF-NM method. The simulated results are statistically evaluated and the proposed modeling method is proved to be better than the other NM. Highlights • The modeling of Diesel engine is done by hybridization method. • Experimental justification assists my hybridization by producing minimal error. • This avoid complex tests to rate blends for getting emission less engine act. [ABSTRACT FROM AUTHOR]

Highlights • Old world bluestem (OWB) pasture with alfalfa favored high soil microbial populations. • Alfalfa with OWB promoted soil organic C, total N and enzymes for nutrient release. • Soil-borne ant deterrence by OWB did not translate into soil microbial inhibition. • OWB-alfalfa mixed pastures can sustain soil health in a water-limited environment. Abstract 'WW-B.Dahl' Old World bluestem [OWB, Bothriochloa bladhii (Retz) S.T. Blake] is a persistent pasture grass in the semi-arid Texas High Plains. Some growers are transitioning their irrigated continuous cotton (Gossypium hirsutum L.) land to dryland or low-irrigation production of WW-B.Dahl owing to diminished water supply. This grass strongly deters soil-dwelling ants (Hymenoptera: Formicidae), presumably via release of unidentified phytochemical repellants in the soil. Our aim was to determine whether the inhibitory effects of OWB extend to soil microbial community structure and function in relation to other adapted forages. We compared soil chemical and microbial properties in a Pullman clay-loam soil for OWB relative to OWB-alfalfa (Medicago sativa L.), alfalfa, and native mixed-grass pastures at 0–5 cm and 10–15 cm depth in June and December of 2016. The pastures ranged in age from 7 to 17 yr. Most measurements of organic forms of C and N showed greatest amounts in OWB-alfalfa; however, not always significantly. Enzyme activities linked to C, N, and S transformations were greatest (P ≤ 0.03) with OWB-alfalfa. This trend was similar for alkaline phosphatase activity, involved in P cycling, but not always significantly. Soil organic C in OWB was 1.2–1.4 fold greater than in the native mix depending on soil depth and sampling date, whereas SOC in OWB-alfalfa was 1.4–1.6 fold greater than in the native mix. Enzyme activities and microbial biomass N (MBN) were likewise greater in OWB and OWB-alfalfa than in the native mix, likely because the latter received no irrigation or N inputs. The microbial community structure demonstrated greater total FAMEs, bacterial markers for Gram+, Gram−, and actinomycetes in OWB-alfalfa compared to OWB, alfalfa, and native mix. Similar results were found in fungal markers for arbuscular mycorrhizal fungi (AMF) and saprophytic fungi. Protozoan indicators were found only in December, of which the native mix had the highest levels in the 0–5 cm depth. In general, selected soil properties, soil microbial biomass, community and enzyme activities were greater in December than in June except AMF, which was greater in June. The stimulating effect of OWB growing with alfalfa on the soil microbial community suggested this forage combination as favorable for soil health in relation to OWB, alfalfa alone, and native mixed-grass pastures. The previously reported inhibitory effect of OWB on soil-dwelling ants did not carry over to a depressing effect on the soil microbial component. [ABSTRACT FROM AUTHOR]

Dielectric elastomers constitute a technologically important class of stimuli-responsive polymers due primarily to their unique ability to achieve large strains (>300 area%) upon exposure to an external electric field. In most reported cases, actuation strains are measured as dielectric elastomers constrained to a circular test configuration essentially waste energy by undergoing isotropic, rather than directional, electroactuation. Recent independent studies have demonstrated, however, that the addition of relatively stiff fibers to a soft dielectric elastomer matrix promotes more energy-efficient anisotropic mechanical behavior and electroactuation response. In this work, we investigate the effects of fiber strain and mechanical properties on electroactuation in anisotropic dielectric electroactive polymers with tunability (ADEPT) fabricated from an acrylic dielectric elastomer. Increases in fiber loading level and stiffness are observed to enhance both mechanical and electroactuation properties to different extents, and we introduce an electroactuation anisotropic enhancement factor to quantify the ratio of electroactuation to mechanical anisotropy. This factor is determined to vary linearly with fiber concentration for nearly all the different ADEPT composites examined in this study. [ABSTRACT FROM AUTHOR]

Cloud computing is becoming increasingly fashionable in distributed computing environment. Processing and Data storage use cloud environment is becoming a movement universal. Software as a Service (SaaS) has on many business applications as well as in our day to day life, we can simply say that this disruptive technology. Cloud computing can be seen since Internet-based computing, in which shared resources, software, and information are made available to devices on demand. It allows resources towards leveraged on per-use basis. It diminishes cost and complexity of service providers by means of assets and operational costs. It allows users to access applications tenuously. On behalf of user, this construct directs cloud service provider to feel software updates and cost of servers etc. For both, cloud providers and consumers; availability, integrity, authenticity, confidentiality, and privacy are important concern. Infrastructure as a Service (IaaS) serves as base layer for many other release models and Platform-as-a-Service (PaaS) clouds. Security of PaaS clouds is considered from multiple perspective including access control, service continuity and privacy while protecting together the service provider and the user. Security problems of PaaS clouds are explored and classified. In this paper we are going to some major security issues of current cloud computing environments. [ABSTRACT FROM AUTHOR]

The problem of boundary layer flow and heat transfer from a plate moving in a quiescent non-Newtonian power law fluid medium is solved numerically to obtain results showing the effects of power-law index and Reynolds number on friction and heat transfer coefficients. A decrease in friction coefficients and an increase in heat transfer coefficients is observed for power-law liquids in comparison with water. Further in the case of a power-law liquid, an increase in the velocity of the plate also produces a reduction in drag and an increase in heat transfer. Compared to a Newtonian liquid, the friction coefficient decreases by 57% for a non-Newtonian liquid of power-law index, n = 0.568 at Re=2000. By increasing the Reynolds number to 10000, the friction coefficient decreases to 66% in comparison with a Newtonian liquid. [ABSTRACT FROM AUTHOR]

Background Improving health-related quality of life (HRQOL), rather than just reducing seizures, should be the principal goal in comprehensive management of childhood epilepsy. There is a lack of population-based data on predictors of HRQOL in childhood epilepsy. Methods The Children with Epilepsy in Sussex Schools (CHESS) study is a prospective, population-based study involving school-aged children (5–15 years) with active epilepsy (on one or more AED and/or had a seizure in the last year) in a defined geographical area in the UK. Eighty-five of 115 (74% of eligible population) children underwent comprehensive psychological assessment including measures of cognition, behaviour, and motor functioning. Parents of the children completed the Quality of Life in Childhood Epilepsy (QOLCE).Clinical data on eligible children was extracted using a standardised pro forma. Linear regression analysis was undertaken to identify factors significantly associated with total Quality of Life in this population. Results Factors independently significantly associated (p < .05) with total QOLCE scores were seizures before 24 months, cognitive impairment (IQ < 85), anxiety, and parent reported school attendance difficulty. These factors were also significantly associated with total QOLCE when children with IQ < 50 were excluded from analysis. Conclusions The majority of factors associated with parent reported HRQOL in active childhood epilepsy are related to neurobehavioural and/or psychosocial aspects of the condition. [ABSTRACT FROM AUTHOR]

Salt-plasticized polyelectrolyte complexes of sodium polystrenesulfonate (Na-PSS) and polydiallyldimethylammonium chloride (PDADMAC) were found to be fully dense (non-porous) when hot-pressed under optimal conditions. The quality of these saloplastics is determined by the molecular weights of polyelectrolytes, the salt type and concentration, as well as processing conditions like pressure and temperature. Higher molecular weights give more compact precipitates that are easy to process while decreasing the molecular weight led to particulate ones. Both the type and concentration of salt on complex formation and doping are explored and are found to play an equally important role. The effects of individual hot-pressing parameters, namely, pressure and temperature are studied thoroughly, facilitating the formation of uniform free-standing films over a wide range of thicknesses from 8 μm to 1 mm. For the first time, saloplastics were studied as free-standing films that are dense even at the nanometer scale. In their dry states, they were brittle and strong, showing a uniform Young's modulus over a range of relevant thicknesses, while the wet states were rubbery and elastic, showing a decreasing trend with thickness. In the wet state, the inverse trend is due to the quicker drying of thin films. Within a single hot-pressing step, protruding shapes and structures from the surface were efficiently made at different length scales. Moreover, saloplastics were also successfully reinforced with thin woven and nonwoven fibers for enhanced tensile strengths, higher than conventional thermoplastics. Overall, this work demonstrates an easy approach to fabricate dense saloplastics and their unique mechanical properties. [Display omitted] • Na-PSS and PDADMAC complexes are varied using salt, concentration, molecular weight. • Optimal complexes are hot-pressed into saloplastics and parameters are studied thoroughly. • Freestanding and completely dense films over a wide range of thicknesses are made. • Tensile tests in wet and dry states show the role of water, stability, strength. • Reinforcements and profiles like chevrons are shown within single step hot-pressing. [ABSTRACT FROM AUTHOR]