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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.

Background There are currently no reference standards for the development of competence in bronchoscopy. Research Question The aims of this study were to (1) develop learning curves for bronchoscopy skill development and (2) estimate the number of bronchoscopies required to achieve competence. Study Design and Methods Trainees from seven North American academic centers were enrolled at the beginning of their pulmonology training. Performance during clinical bronchoscopies was assessed by supervising physicians using the Ontario Bronchoscopy Assessment Tool (OBAT). Group-level learning curves were modeled using a quantile regression growth model, where the dependent variable was the mean OBAT score and the independent variable was the number of bronchoscopies performed at the time the OBAT was completed. Results A total of 591 OBAT assessments were collected from 31 trainees. The estimated regression quantiles illustrate significantly different learning curves based on trainees’ performance percentiles. When competence was defined as the mean OBAT score for all bronchoscopies rated as being completed without need for supervision, the mean OBAT score associated with competence was 4.54 (95% CI, 4.47-4.58). Using this metric, the number of bronchoscopies required to achieve this score varied from seven to 10 for the 90th percentile of trainees and from 109 to 126 for the lowest 10th percentile of trainees. When competence was defined as the mean OBAT score for the first independent bronchoscopy, the mean was 4.40 (95% CI, 4.20-4.60). On the basis of this metric, the number of bronchoscopies required varied from one to 11 for the 90th percentile of trainees and from 83 to 129 for the lowest 10th percentile of trainees. Interpretation We were able to generate learning curves for bronchoscopy across a range of trainees and centers. Furthermore, we established the average number of bronchoscopies required for the attainment of competence. This information can be used for purposes of curriculum planning and allows a trainee’s progress to be compared with an established norm.

Number Plate recognition, also called License Plate realization or recognition using image processing methods is a potential research area in smart cities and Internet of Things. Many of the existing automated number plate recognition systems work only in a controlled environment where images are captured from a straight angle with good illumination, clarity and standard fonts. Another drawback of existing works is that, they are based on UK number plates and may not suite for Indian number plates. This paper presents a novel image processing system for Indian number plate detection and recognition that can deal with, noisy, low illuminated, cross angled, non-standard font number plates. This work employs several image processing techniques such as, morphological transformation, Gaussian smoothing, and Gaussian thresholding in the pre-processing stage. Next, for number plate segmentation, contours are applied by border following and contours are filtered based on character dimensions and spatial localization. Finally, after the region of interest filtering and de-skewing, K-nearest neighbor algorithm is used for character recognition. The proposed methods demonstrated promising results.

In the field of coatings, there is a major trend towards the reduction of volatile organic compounds by developing water-based alternatives for traditional solvent-based paints. Complexes of oppositely charged polyelectrolytes have recently emerged as a promising candidate for such coatings. Recently, we developed an ammonia-evaporation induced complexation approach to form polyelectrolyte complex films of two weak polyelectrolytes in a single step. Here, we extend this method by applying it to a combination of PEI/PSS, a weak polycation and a strong polyanion. Homogenous solutions at different ratios were successfully prepared. After casting and drying, dense and optically transparent layers were formed. As a comparison, PEI/NaPSS was also studied. Contrary to PEI/PSS, the pH in PEI/NaPSS films remains high during drying and NH3 evaporation, so PEI does not acquire a positive charge, thereby preventing complexation. We show that this leads to large differences in the properties of the films, with the PEI/NaPSS films being more sensitive to water, more ductile, and more prone to phase separation. We also found that the mechanical properties of the films depend strongly on the charge ratio: films made at a PEI/PSS ratio between 2:1 and 1:1 formed the strongest complexes, resulting in films that swell relatively little in water, but that are also brittle and prone to cracking during drying. In this work, we report a systematic study into this promising system and show its potential and tunability.

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.

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).

MtrAB is one of the important two-component regulatory systems (2CRS) in mycobacteria and consists of MtrB sensor kinase and MtrA response regulator. Mycobacterium smegmatis mtrB mutant is filamentous and shows defects in cell division, cell shape and optimal expression of the MtrA-regulon. In an effort to identify M. tuberculosis sensor kinases that work with MtrA and/or bypass the need for MtrB, we attempted to overexpress other M. tuberculosis sensor kinases in M. smegmatis mtrB background and reverse the mtrB phenotype. Overexpression of trcS kinase, but not nine others tested, reversed the mtrB mutant phenotype including the expression of the MtrA-regulon. However, the overexpression of trcS kinase did not reverse the mutant phenotype of a mtrA mutant. Bacterial-two hybrid assays revealed that the TrcS kinase interacts with both MtrB kinase and the response regulator MtrA. Recombinant TrcS protein exhibits autophosphorylation and transphosphorylation of its cognate response regulator TrcR, and MtrA. Together, these results support a model involving cross-talk between the MtrAB and TrcRS two-component systems.

The aim of the study was to gain a comprehensive understanding of the experiences and needs of parents of young children with epilepsy from a total population sample. The parents (mothers (n = 38), fathers (n = 9)) of 40/53 (75% of total population) young children (1-7 years; 23 males, 17 females) with 'active' epilepsy (had a seizure in the last year or taking Anti-epileptic drugs (AEDs)) were interviewed either in person or over the telephone using a semistructured interview schedule. The families were resident in the south of the UK. The interviews were audio-recorded, transcribed, and coded using thematic analysis. Thematic analysis revealed six main themes: diagnostic journey, parental perception of epilepsy management, awareness and impact of associated neurobehavioral difficulties, inconsistent availability of therapeutic and educational supports, impact on family functioning, and need for parental support. Parents reported often having difficulty accessing a professional knowledgeable about epilepsy. While parents were generally satisfied with the initial information they received about seizures and their management, they reported that the association between epilepsy and neurobehavioral issues was often not broached. These developmental/behavioral difficulties often had a bigger impact on child wellbeing and family functioning, but provision of therapeutic and educational supports for the difficulties was often very patchy. Parents noted that early onset epilepsy and associated neurobehavioral difficulties often have a very significant impact on family functioning including increased restrictions on family activities and increased financial burden. Parents would like informational and emotional support to extend beyond the time of epilepsy diagnosis. There is a clear need for comprehensive childhood epilepsy services to include provision for identification and management of child neurobehavioral needs and a focus on family-centered care.

The impact of heat generated inside the porous layer containing a fluid and density maximum when the porous structure is studied analytically subjected to rotation for the case of unlike temperatures of both solid and fluid phases. Two equations each representing solid and fluid phases are used as energy equations. The linear stability theory is used and is based on normal mode technique. Galerkin method is used to find the Eigen values of the problem. The rotation of the porous layer provides extra strength to the system, protecting the structure from instability, however internal heat generation does not support the system in retaining its strength, causing the system to destabilize. Both the conductivity ratio and the density function have a negative impact on system stability. Consequently, the rotation parameter

‘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.

The aim was to provide data on parenting stress and perceived stigma in mothers (n = 47) of young children with epilepsy, and to compare findings with those of mothers (n = 48) of developmental, age- and gender-matched children with nonepilepsy-related neurodisability (neurological and/or neurodevelopmental concerns). The mothers of young children (1-7 years) with epilepsy and mothers of children with neurodisability in a defined geographical area of the UK, completed the Parenting Stress Index-4th Edition (PSI-4) and a measure of perceived stigma. Factors associated with parenting stress and stigma were analyzed using linear regression. Thirty-eight percent of mothers of children with epilepsy scored in the at-risk range (85th percentile) on the Total Stress score of the PSI-4 (Neurodisability 21%) (p = 0.06). Significantly more mothers of children with epilepsy scored in the at-risk range on the Parent-Child Dysfunctional Interaction subscale than mothers of children with neurodisability (Epilepsy 45% vs. Neurodisability 21%; p = 0.01), but not on the Parental Distress subscale (Epilepsy 32% vs. Neurodisability 23%; p = 0.33) or Difficult Child (Epilepsy 57% vs. Neurodisability 46%; p = 0.26) subscales. There was no statistically significant difference in perceived stigma between mothers in both groups (p = 0.51). Factors significantly associated with increased parenting stress in the group with epilepsy were child behavior difficulties (p 0.001) and maternal sleep difficulties (p = 0.02). Lower child developmental level was the only factor independently associated with increased stigma in the group with epilepsy (p = 0.08). Mothers of young children with epilepsy report high levels of parenting stress and higher levels of difficulties with parent-child interaction compared with that of mothers of children with nonepilepsy-related neurodisability. Parenting stress and stigma in epilepsy were not associated with epilepsy factors. Efforts at reducing parenting stress and stigma should focus on interventions targeting child development and maternal sleep.