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Nasogastric tubes (NG) used for enteral nutrition support of medically complex children (MCC) are often inadvertently removed, risking frequent replacements. Bridles have been shown to provide a safe securement method for NGs in adult patients, but are not widely used in pediatrics. Furthermore, nutritional management of MCC is often fragmented. We established a pediatric NG bridle program to bridge the gap amongst disciplines and improve patient outcomes. In January 2018, a multidisciplinary work group involving nurses, physicians, clinical dietitians, advanced practice providers, and speech-language pathologists was established to develop criteria for patient referral and policies, procedures, and order sets for nutritional management of MCC children with bridled NG tubes. Formal teaching sessions engaged clinicians and administrators to participate in building a successful program. Relevant outcomes of interest are tracked continuously for process performance improvement measures and are reviewed quarterly by the core work group. Patient enrollment began in May 2018 and to date, 244 patients have been enrolled. Adhering to strict enrollment criteria, competency modules and review of patient status provided a solid core for the program and process review. Successful implementation of an NG Bridle program was achieved. Outcomes of interest continue to be monitored for process improvement. Balancing measures are also being tracked for potential downstream effects. • Nasogastric tubes used to provide nutrition support are often dislodged. • Medical care across specialties often results in fragmented nutritional management. • Bridled nasogastric tubes provide a safe securement method for pediatric patients. • A nasogastric bridle program induces multidisciplinary collaboration across the care continuum. [ABSTRACT FROM AUTHOR]

The study provides a comprehensive examination of single row Rectangular Pile Head Breakwaters (RPHB), encompassing both non-perforated and perforated variations. In the non-perforated RPHB category, the investigation delves into the effects of pile head height and width, and wave climate. For perforated RPHB structures, the study analyses the influence of percentage of perforations, perforation size, and depth of water. Further, the research includes a comparative assessment between non-perforated and perforated RPHB structures. Additionally, the research conducts a comparative analysis with similar structures. In the case of non-perforated RPHB, the configuration with relative pile head diameter (D/d) of 2.4 and relative pile head height (Y/H max) of 1.5 stood out as the most effective model. Similarly, the perforated RPHB demonstrated its maximum wave attenuation potential with percentage of perforations (P) of 24% with relative size of perforations (S/D) of 0.25. This optimal configuration achieved a minimal wave transmission coefficient (K t) of 0.53, reflection coefficient (K r) of 0.33, and energy dissipation coefficient (K d) of 0.79 at a relative water depth (h/H) 0.865. Notably, the introduction of perforations on the RPHB structure led to an improvement in wave attenuation performance by 4–8%, resulting in lower reflection and higher energy dissipation. Comparatively, the RPHB structure outperformed the Enlarged (cylindrical) Pile Head Breakwater (EPHB) and Conical Pile Head Breakwater (CPHB) structures in terms of wave attenuation, exhibiting higher reflection and superior energy dissipation characteristics. The consistent outcome of these investigations reveals that the RPHB exhibits superior hydrodynamic performance characteristics and design suitability, making it a promising choice for breakwater applications. • The perforated RPHB is found to perform better in wave attenuation than the non-perforated counterpart. • The RPHB demonstrated superiority in wave attenuation compared to other similar structures, with higher energy dissipation. [ABSTRACT FROM AUTHOR]

In this paper, the design of robust non-overshooting (NO) controllers for output regulation is presented for a continuous linear time-invariant (LTI), multi-input multi-output (MIMO) state feedback based descriptor system. In this method of controller design for descriptor system, the integral sliding mode (ISM) technique along with generalised Moore's eigen structure assignment method and output regulation theory for descriptor system is invoked to ensure robust output regulation with NO behavior. The efficiency of the proposed controller is also demonstrated with the help of a numerical example and simulation results presented at the end. [ABSTRACT FROM AUTHOR]

This paper introduces a robust non-overshooting tracking controller for descriptor systems based on an Integral Sliding Mode (ISM) technique. Non-overshooting controllers (NOS) are a class of controllers which provide good transient response while tracking without any overshoots. But, NOS controllers developed so far for the descriptor systems are not robust to disturbances. So, to provide robustness against matched disturbances, here an integral sliding mode based non-overshooting controller is proposed. Hence, good transient performance without any overshoot during tracking and robustness can be ensured at the same time. Simulation results are given towards the end, which confirms the efficacy of the proposed methodology. [ABSTRACT FROM AUTHOR]

From an initial list of nonnegative integers, we form a Stanley sequence by recursively adding the smallest integer such that the list remains increasing and no three elements form an arithmetic progression. Odlyzko and Stanley conjectured that every Stanley sequence ( a n ) satisfies one of two patterns of asymptotic growth, with no intermediate behavior possible. Sequences of Type 1 satisfy α / 2 ≤ lim inf n → ∞ a n / n log 2 3 ≤ lim sup n → ∞ a n / n log 2 3 ≤ α , for some constant α , while those of Type 2 satisfy a n = Θ ( n 2 / log n ) . In this paper, we consider the possible values for α in the growth of Type 1 Stanley sequences. Whereas Odlyzko and Stanley considered only those Type 1 sequences for which α equals 1, we show that α can in fact be any rational number that is at least 1 and for which the denominator, in lowest terms, is a power of 3. [ABSTRACT FROM AUTHOR]

In this paper, implicit systems with uncertain input matrix subjected to matched Lipschitz disturbances are considered. For such kind of systems a Lipschitz continuous control, achieving admissible solutions for implicit systems is proposed. The developed methodology consists of two steps. In the first step a stable sliding surface is designed after transforming the original system into a regular like form. Then a first order sliding mode controller through an integrator is designed which will ensure finite-time convergence to the sliding manifold and the exponential convergence to the origin in spite of the presence of Lipschitz disturbances and uncertain input matrix. [ABSTRACT FROM AUTHOR]

Abstract: Multi-component high entropy alloys (HEAs) are observed to form simple solid solutions in contrary to general perception that complex compounds may form in such multi-component equi-atomic alloys. In the present study, alloying behavior was investigated using XRD in AlCoCrCuFe and NiCoCrCuFe equi-atomic high entropy alloys synthesized by mechanical alloying (MA) and spark plasma sintering (SPS). Simple FCC and BCC phases evolved after MA, while Cu-rich FCC and sigma (σ) phases evolved along with FCC and BCC phases after SPS. Further, NiCoCuFe, NiCoCrFe and NiCoFe equi-atomic alloys were investigated to confirm the formation of Cu-rich FCC, and σ phases. The hardness was observed to be 770±10HV for AlCoCrCuFe and 400±10HV for NiCoCrCuFe. Phase evolution after MA and SPS indicate that configurational entropy is not sufficient enough to suppress the formation of Cu-rich FCC, and σ phases, and enthalpy of mixing appears to play an important role in determining the phase formation in high entropy alloys after sintering. [Copyright &y& Elsevier]

Abstract: The aim of the present study was to develop proliposomal formulations to enhance the oral bioavailability of exemestane by improving solubility, dissolution and/or intestinal permeability. Proliposomal powder formulations were prepared using different ratios of drug (exemestane), distearoyl–phosphatidylcholine (DSPC), cholesterol and dimyristoyl–phosphatidylglycerol (DMPG) by solvent evaporation method. The effect of phospholipid composition and drug:lipid ratio on in vitro performance of proliposomes was studied. Proliposomes were characterized for their particle size distribution, thermal characteristics by differential scanning calorimetry (DSC) and dissolution behavior. Further, the formulated proliposomes were subjected to in vitro permeation or transport studies using different models such as rat intestine, parallel artificial membrane permeability assay (PAMPA) and Caco-2 cell line. Proliposomes provided enhanced exemestane dissolution due to incorporation into the phospholipid bilayers and change in the physical state from crystalline to amorphous. The in vitro transport studies in rat intestine, PAMPA and Caco-2 models revealed that the proliposomes were successful in enhancing the permeation of exemestane. These proliposomal formulations of exemestane could provide improved oral bioavailability due to enhanced solubility, permeability and hence absorption. [Copyright &y& Elsevier]

An economical, ecofriendly and efficient breakwater system is vital for coastal protection and harbour tranquility. In this regard, various researchers are working to develop the appropriate solutions to encounter site-specific challenges. With this viewpoint, concept of enlarged pile head breakwater is developed. The study focuses on improving the hydraulic efficiency of pile breakwater by enlarging the structure near the free surface and providing it with perforations. Effect of percentage distribution of perforations, size of perforations and percentage of perforations on wave transmission, reflection and dissipation characteristics of the structure is investigated. The physical experiments are conducted in a two-dimensional wave flume under varying monochromatic wave climates. Results indicate that the pore size highly dominants the wave attenuation than considering the increasing percentage of perforations with the small size of the pore. Perforations effectively reduce the K t of about 10%–18% to that of non-perforated pile head breakwater. Hydraulic efficiency of enlarged pile head breakwater is optimum when D/H max = 0.6, Y/H max = 1.0, b/D = 0.2, S = 0.25D, pa = 75% and P = 22.5 at 0.3 m water depth. A hybrid theoretical solution is developed based on the current set of experimental data for the quick estimate of hydraulic coefficients. The proposed hybrid equation for the perforated pile breakwater predicts more desirable values of K t , K r and K d. The proposed concept of breakwater gives a reasonably enhanced hydraulic efficiency than the compared type of breakwaters. • The experimental study is carried out to determine the hydraulic characteristics of perforated enlarged pile head breakwater. • The study is conducted for various configuration of perforations under regular wave climatic conditions. • Results indicate that the perforations improve the wave attenuation and pore size highly dominants the wave attenuation. • A hybrid theoretical solution is developed and validated with the present experimental data. [ABSTRACT FROM AUTHOR]

Breakwaters are constructed for dissipating the wave energy and safeguarding the coastline from destructive wave forces. Conventional pile breakwater built using prismatic circular piles has been proven to provide partial protection efficiently. In the present study, the conventional pile breakwater is modified by widening the pile's cross-sectional area at the surface level in a conical shape. The concept of introducing the conical shape is to attenuate the concentrated wave energy, mainly focusing at the surface. The influence of the structural parameters such as diameter, height and clear spacing of the conical pile head is investigated experimentally for various monochromatic wave climatic conditions. The investigation is also focused on determining the influence of the second row on performance characteristics. The analysis shows that the least transmission coefficient (K t) of 0.662 for the configuration of D/H max = 0.4, Y/H max = 1.5 and b/D = 0.1 for a single row of piles. Further, the second row of piles' inclusion resulted in improved attenuation characteristics of conical pile head breakwater (CPHB) with the least K t of 0.582 at an optimal B/D of 0.4. The performance of the CPHB is compared with the theoretical solutions of conventional pile breakwater. The results indicate that the introduction of pile head on conventional pile breakwater is beneficial in improving wave attenuation. A set of empirical equations is developed based on the experimental values for quick prediction of K t and K r. The estimated values of K t and K r are in line with the experimental data with a coefficient of determination (R2) of 0.91 and 0.90, respectively. The overall performance of the CPHB is found to be promising as a potential coastal protection structure. • A novel idea of conical pile head breakwater is proposed by enlarging the circular pile's cross-sectional area. • The performance characteristics are studied experimentally for different structural configurations under regular waves. • The comparative study of CPHB with the conventional pile breakwater proved to be advantageous in wave attenuation. • Empirical equations are developed and validated based on experimental data. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of pediatric feeding disorder (PFD) in US children.Study Design: We conducted a retrospective cohort study of Medicaid Databases from Arizona (2009-2017) and Wisconsin (2005-2014) (public insurance databases) and The Truven Health Analytics MarketScan Commercial Claims and Encounters Database (2009-2015) (a nationwide private insurance database). Diagnoses and procedures were identified from inpatient and outpatient claims using the International Classification of Diseases (ICD)-9 and ICD-10 diagnostic codes and ICD and Current Procedural Terminology-4 procedure codes. Children with PFD were identified by presence of 1 or more PFD diagnosis and absence of any eating disorder diagnoses within a calendar year.Results: We identified 126 002 and 367 256 children 5 years of age or younger with PFD with public and private insurance, respectively. Over a 5-year period (2009-2014) the prevalences of PFD in children with public insurance in Arizona and Wisconsin were 32.91 (95% CI, 32.61-33.20) and 34.73 (95% CI, 34.37-35.09) children per 1000 child-years, respectively. Similarly, the prevalence of PFD in private insurance carriers was 21.07 (95% CI, 21.00-21.14) children per 1000 child-years. The prevalence trends showed a significant linear increase in children within both insurance cohorts. In 2014, the annual prevalence of PFD was 1 in 23, 1 in 24, and 1 in 37 in children under 5 years in the publicly insured cohorts in Wisconsin, Arizona, and the privately insured cohort, respectively.Conclusions: The prevalence of feeding disorders in the US rivals that of commonly diagnosed conditions such as eating disorders and autism. [ABSTRACT FROM AUTHOR]

• Effect of carbon black and anisotropic filler on vibration damping of polyurethanes. • Effect of structural variables on system loss factors for filled elastomers. • Correlation between material damping and system loss factor. The dynamic properties of filled elastomers have been a subject of both fundamental and applied research interest. We report on the tunable and synergistic effect of carbon black and anisotropic additives on the viscoelastic and vibration damping properties of a segmented polyurethane (PU). To this end, PU composites were prepared using aramid short fiber and graphite as micro- scale additives and organically modified nanoclay as the nano- scale anisotropic additive in conjunction with carbon black. The degree of hydrogen bonding, phase and filler dispersion morphology of the composites were ascertained by Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), small angle X-ray scattering (SAXS) and transmission electron microscopy (TEM). Dynamic mechanical analysis of the composites revealed an additive induced decrease in the intensity of the dissipation factor, tan δ , implying immobilization of polymer chains in the vicinity of the filler surfaces and significant reinforcement effect of fillers on the PU matrix. The composite system loss factor evaluated from the modal analysis of frequency response, in constrained layer damping mode, revealed loss factor values in the range 0.1–0.2 (at 710 Hz), as against the corresponding value of 0.027 for the bare metal beam. A salient finding of the present study was the filler induced enhancement in system loss factor, while the tan δ magnitude decreased, which has been reconciled with several causal mechanisms. [ABSTRACT FROM AUTHOR]

Coastal erosion of beaches has been a common problem around the world. One of the eco-friendly control measures for coastal erosion is to dissipate the energy of waves impinging on the shores by constructing offshore breakwater. Pile breakwater is one such type of offshore breakwater that consists of a number of closely spaced piles. Construction of piles at closer spacing is highly challenging and expensive. This problem can be addressed by reducing the number of piles and modifying the pile with an enlarged head in the vicinity of the water surface, where wave energy is concentrated. In the present study, an experimental investigation on the hydraulic performance of enlarged pile head breakwater is conducted in a wave flume. The concept breakwater is subjected to monochromatic waves of varying wave heights, wave periods and water depth. The experimental results show that the least value of transmission coefficient is 0.62 and reflection coefficient is 0.123 with the highest value of dissipation coefficient of 0.77 for the structural configuration of b/D ratio of 0.2, D/H max of 0.6 and Y/H max of 1.0 at a water depth of 0.3 m. Observed results are encouraging and are in line with the similar type of pile breakwaters in a single row. The present experimental data is also validated with the available theoretical solutions. Since the results from the compared theoretical solution are not in good agreement, a hybrid theoretical model is reconstructed based on experimental results of pile head breakwater. The proposed modified version of the hybrid equation predicts encouragingly better transmission, reflection and dissipation coefficient than the existing solutions. Moreover, the results predicted by the proposed hybrid equation are in good agreement with that of other similar pile breakwater models. • Conventional pile breakwater is modified by increasing the size of the pile near the water surface. • Improved hydraulic characteristics of enlarged pile breakwater is obtained when b/D = 0.2, D/H max = 0.6, and Y/H max = 1.0. • A hybrid theoretical model is reconstructed based on experimental results of enlarged pile head breakwater. • Observed results are encouraging and are in line with the similar type of pile breakwaters in a single row. [ABSTRACT FROM AUTHOR]

Biogenesis of the iron-sulfur (Fe-S) cluster is an indispensable process in living cells. In mammalian mitochondria, the initial step of the Fe-S cluster assembly process is assisted by the NFS1-ISD11 complex, which delivers sulfur to scaffold protein ISCU during Fe-S cluster synthesis. Although ISD11 is an essential protein, its cellular role in Fe-S cluster biogenesis is still not defined. Our study maps the important ISD11 amino acid residues belonging to putative helix 1 (Phe-40), helix 3 (Leu-63, Arg-68, Gln-69, Ile-72, Tyr-76), and C-terminal segment (Leu-81, Glu-84) are critical for in vivo Fe-S cluster biogenesis. Importantly, mutation of these conserved ISD11 residues into alanine leads to its compromised interaction with NFS1, resulting in reduced stability and enhanced aggregation of NFS1 in the mitochondria. Due to altered interaction with ISD11 mutants, the levels of NFS1 and Isu1 were significantly depleted, which affects Fe-S cluster biosynthesis, leading to reduced electron transport chain complex (ETC) activity and mitochondrial respiration. In humans, a clinically relevant ISD11 mutation (R68L) has been associated in the development of a mitochondrial genetic disorder, COXPD19. Our findings highlight that the ISD11 R68A/R68L mutation display reduced affinity to form a stable subcomplex with NFS1, and thereby fails to prevent NFS1 aggregation resulting in impairment of the Fe-S cluster biogenesis. The prime affected machinery is the ETC complex, which showed compromised redox properties, causing diminished mitochondrial respiration. Furthermore, the R68L ISD11 mutant displayed accumulation of mitochondrial iron and reactive oxygen species, leading to mitochondrial dysfunction, which correlates with the phenotype observed in COXPD19 patients. [ABSTRACT FROM AUTHOR]

In the present investigation, an attempt has been made to weld the precipitation hardened Nickel based super alloy Inconel 718 and austenitic stainless steel AISI 316L using Continuous Current Gas Tungsten Arc Welding (CCGTAW) and Pulsed Current Gas Tungsten Arc Welding (PCGTAW) process employing ER2553 and ERNiCu-7 fillers. Microstructure examination using optical and SEM analysis clearly witnessed the formation of unmixed zone at the Heat Affected Zone (HAZ) of Inconel 718 for all the joints. The studies showed the absence of deleterious phases in the CCGTA and PCGTA weldments employing ERNiCu-7. Tensile studies corroborated that the fracture occurred at the parent metal of AISI 316L in all the cases. It was inferred from the present study that PCGTA weldments employing ERNiCu-7 exhibited better metallurgical and mechanical properties. This study articulated the effect of filler metals on the structure-property relationships of the weldments. [ABSTRACT FROM AUTHOR]

Highlights • The effect of heat stress can be alleviated by nitric oxide (150 μM) treatment in wheat. • Nitric oxide triggers the expression of SAGs and enhances the scavenging potential of wheat under heat stress. • Nitric oxide improves the quality of wheat grain by enhancing the accumulation of gliadin protein and starch. • Nitric oxide maintains the quality of starch in wheat grain by reducing the amylolytic activity under heat stress. • Nitric oxide enhances the accumulation of soluble protein, free amino acids and osmolyte in developing grains under HS. Abstract Heat stress (HS) drastically reduces the yield and quality of wheat grains. High temperature during critical stages (pollination and grain-filling) causes improper fertilization and formation of defragmented granules and shriveled seeds. Hormones and signaling molecules modulates the tolerance potential of the plants under stress. Nitric oxide (NO) is an important signaling molecule involved in triggering diverse physiological and biochemical processes under adverse conditions. Here, we studied the effect of sodium nitroprusside (SNP) (150 μM set based on pilot experiment) on heat stress-tolerance and grain quality related traits of two contrasting wheat cultivars Raj3765 as thermotolerant and HD2932 as thermosusceptible under differential HS (T 1 - 30 °C, 1 h; T 2 - 38 °C, 1 h), as compared to control (22 ± 2 °C) at different stages of growth. The expression of many important stress-associated genes (previously identified through Transcriptome sequencing) was observed upregulated in response to NO and HS; small HSP17 showed maximum fold increase in Raj3765. Similarly, the networks of antioxidant enzymes (SOD, CAT, and GPX) were observed triggered in response to NO, HS and NO + HS treatment in Raj3765 than HD2932. The accumulation of proline and free amino acid in cytoplasm were also reported higher under NO and HS treatment respectively in Raj3765, as compared to HD2932. Grain quality related traits like carbohydrate (starch) and proteins (gliadin) were observed higher in response to NO under HS in Raj3765. Heat stress was observed to increase the activities of α/β amylases in developing grains involved in degrading the starch quality. NO was observed to decrease the amylolytic activity in both the cultivars; very low amylolytic activity was observed in thermotolerant, as compared to thermosusceptible cultivars. Exogenous application of NO (150 μM) at different stages can be used as inexpensive technology for mitigating the problem of terminal HS in wheat – a farmer friendly approach for maintaining the quality of grains under present threat of global climate change. [ABSTRACT FROM AUTHOR]

A library of seventeen novel 1,2,3-triazole derivatives were efficiently synthesized in excellent yields by the popular ‘click chemistry’ approach and evaluated in vitro for their anti-tubercular activity against Mycobacterium tuberculosis H37Ra (ATCC 25177 strain). Among the series, six compounds exhibited significant activity with minimum inhibitory concentration (MIC) values ranging from 3.12 to 0.78 μg/mL and along with no significant cytotoxicity against MBMDMQs (mouse bone marrow derived macrophages). Molecular docking of the target compounds into the active site of DprE1 (Decaprenylphosphoryl-β- d -ribose-2′-epimerase) enzyme revealed noteworthy information on the plausible binding interactions. [ABSTRACT FROM AUTHOR]

Background: The optimal success of bactericidal therapy against Enterococcal infections currently relies on the use of the synergistic combination of a cell wall-active agent, a penicillin or a glycopeptide, with an aminoglycoside (gentamicin/streptomycin). Nonetheless, the acquisition of ribosomal mutations and/or aminoglycoside modifying enzymes (AGMEs) had led to the emergence of high-Level aminoglycoside resistant strains that pose a significant therapeutic challenge. Hence, the study was aimed to detect the incidence of HLAR among the non-urinary Enterococcal isolates. Methods & Materials: Twenty six non-urinary isolates of Enterococcus species (E. faecalis (n = 15), E. facium (n = 5), Enterococcus spp (n = 6)) isolated from pus (n = 20), fluids (n = 5) and blood (n = 1) were included in the study. Susceptibility to vancomycin (30μg), teicoplanin(30g), linezolid(30μg), gentamicin(120μg), streptomycin(300μg) and screening for HLAR was performed as per CLSI, 2015. Molecular detection of the genes encoding vancomycin, aminoglycoside resistance viz.,vanA, vanB, aac(6')-Ie-aph(2")-Ia, aph(2")-Ib, aph(2")-Ic, aph(2")-Id, aph(3")-IIIa and ant(4')-Ia was carried out by multiplex PCR. Results: High-level resistance to gentamicin and streptomycin (HLGR HLSR) was observed in 14 (53.8%) isolates while, 6(23.1%), 2(7.7%) isolates exhibited HLGR HLSS and HLGS HLSR phenotype respectively. MIC of gentamicin and streptomycin of the HLGR, HLSR isolates was found to be > 500μg/ml and >2000μg/ml respectively. aac(6')-Ie-aph(2")-Ia and aph(3")-IIIa were detected in 5(22.7%) and 1(4.5%) of the HLAR isolates respectively while, 9(40.9%) of the HLAR isolates harboured both aac(6')-Ie-aph(2")- Ia and aph(3")-IIIa. None of the isolates exhibited resistance to teicoplanin and linezolid. Neverthless, one isolate exhibited intermediate resistance to vancomycin by disc diffusion but was confirmed to be susceptible by E-test and did not harbour vanA and vanB. Conclusion: Aminoglycosides are the most frequently prescribed antibiotics in clinical practice as they possess good pharmacokinetics and exhibit synergism with beta-lactams and glycopeptides. However, we report an increased incidence of HLAR among the non-urinary Enterococcal isolates. This is indicative of an increased dissemination of aminoglycoside resistance genes in our geographical setting. Hence, prompt detection and characterization of HLAR strains is essential as these have lost synergism with the cell wall active agents. Also, absence of VRE could be attributed to the restricted usage of vancomycin in our setting. [ABSTRACT FROM AUTHOR]

Objective To analyse the clinical presentation, treatment – primary and secondary debulking and outcomes with focus on recurrences in ovarian immature teratoma. Study design This is a single institution, retrospective analysis of 24 women who presented to a gynecologic oncology unit from 1999 to 2011 with ovarian immature teratoma. Patient's clinical presentation, operative and chemotherapy details were included in a database. Follow up details regarding recurrence and management and future outcomes were also noted. Overall survival was calculated from the date of registration to last follow up or date of death. Survival curve was constructed by Kaplan–Meier method. Results Immature teratoma accounted for 11% of 218 malignant germ cell tumors. Of the 24 patients, pain was the predominant symptom and abdominal mass was the commonest clinical presentation. Sixteen out of 24 patients presented in Stage I and grade 3 tumors were found in 43% of patients. Six patients had only unilateral salpingo oophorectomy and no staging procedure. Twelve patients underwent staging, with omentectomy being the commonest procedure. All but one, had cisplatin based combination chemotherapy. Six patients underwent secondary debulking of recurrence. Most recurrences were recorded in Stage III, higher grade tumors. With secondary cytoreduction and platinum based chemotherapy, it was possible to salvage most recurrences as well. Overall survival after a mean follow-up of 39 months was 91.6%. Conclusion Majority of the patients did well with conservative surgery in terms of survival, menstrual and reproductive function. Platinum based chemotherapy was indicated in higher grade and higher stage tumors as recurrences commonly occurred in this subgroup of patients. Recurrences could be salvaged with selected secondary cytoreduction and platinum based chemotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Background: Establishing a caloric requirement or energy target is a recommended part of any nutrition care plan. Objective: Our objective was to describe early documentation of a caloric requirement in critically ill children, and to determine if this would have any effect on daily energy intake and route of nutrition. Design: We used a descriptive chart review of a subgroup of patients included as part of a larger, retrospective multicenter study. Variables of interest included nutritional intake information, as well as presence/absence and amount of a documented caloric requirement within 48 hours of admission. Participants: Five of the original 12 study centers collected the required supplementary data. Enrolled patients were those who were admitted to our pediatric intensive care unit (PICU) from January 1, 2007, through December 31, 2008; were between ages 30 days and 18 years; and had a length of stay in the PICU ≥96 hours. Statistical analysis: Energy intake among patients with and without a documented caloric requirement was analyzed using Mann-Whitney U tests. The difference of receiving enteral nutrition among patients with and without a caloric requirement was analyzed using a χ2 test. Results: We studied 1,349 patients, of whom 644 (47.7%) had a caloric requirement documented (95.6% of caloric requirements were entered by a registered dietitian) in the medical record; these patients had higher total daily energy intake and were more likely to be fed enterally during the first 4 days of PICU admission than those without a documented caloric requirement (P<0.001 for all comparisons). Conclusions: Less than half of critically ill children studied had a caloric requirement documented in the medical record; when a caloric requirement was documented in the medical record of a critically ill child, a registered dietitian had likely made the note. Having a caloric requirement documented in the medical record is associated with a higher energy intake and the use of the enteral route. [Copyright &y& Elsevier]

Abstract: Poly(2-hydroxyethyl methacrylate-silica) hybrid materials with significantly lower volume shrinkage were synthesized by using acid-catalyzed sol–gel reactions of tetraethyl orthosilicate and free radical polymerization of 2-hydroxyethyl methacrylate (HEMA). The mechanical, thermal, and optical properties and internal porosities of the poly(HEMA-silica) hybrids with different silica contents (e.g., 15, 25 and 30wt%) were evaluated with the use of nanoindentation, microscratch, thermogravimetric analysis, differential scanning calorimetry, dynamic mechanical analysis, UV–vis spectrophotometer and N2 adsorption–desorption method. A silica percolation threshold was found at around 20–25wt%, beyond which a marked increase in the poly(HEMA-silica) hybrid hardness and modulus was observed as compared to pure poly(HEMA). Nanoindentation and scratch testing measurements also for the first time were introduced in characterizing poly(HEMA-silica) hybrid materials. [Copyright &y& Elsevier]