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Introduction This case series describes use of the Acurate Neo transcatheter aortic valve in patients with symptomatic severe native aortic regurgitation (AR). TAVI is not currently mentioned in either the European Society of Cardiology or American College of Cardiology guidance for management of severe symptomatic AR. There are no randomised trials comparing the outcomes of patients with pure severe AR treated with a TAVI valve vs surgical aortic valve replacement (sAVR). Method We present a case series of four patients with isolated AR treated using the Acurate Neo valve (Boston Scientific). Each case had been turned down for sAVR but deemed suitable for TAVI after review at the structural heart multi-disciplinary team meeting. TAVI implantation was successful in each case with reduction or resolution of their AR and improved cardiac haemodynamics. Results Three of the patients had significant symptomatic improvement, one had limited symptomatic improvement despite resolution of her AR on aortogram post TAVI. Conclusion Our case series adds to the growing literature that TAVI is a viable option for patients with pure AR but further long-term follow-up is required to assess the longevity and robustness of the valves.

The purpose of this research is to explore the complications of the expansion of School Choice Programs (SCP) and the integration of an African-centered curriculum, education, thought, and schools into American public schools and school choice programs. The complications deal with the issues of the Zero Tolerance Policy (ZTP), No Excuses Model, School to Prison Pipeline (STPP), and discriminatory practices that impact students of color at a higher rate than whites such as racial and economic segregation, expulsions, suspensions, and dropout rates, which evidence shows leads to juvenile and incarceration arrests. In order to correct the complications, the framework of African Centered Thought (ACT) based on Dr. Jacob Carruthers, and Critical Race Theory (CRT) should be implemented into the SCP for an African centered curriculum, education, thought, and schools.

Introduction Safety and efficacy data on patent foramen ovale (PFO) closure with the Occlutech Figulla Flex II device are lacking. We undertook a fully monitored prospective Registry on PFO closure using this device. Methods 100 patients undergoing PFO closure were enrolled into the OPPOSE Registry at 6 UK centres. The primary endpoint was PFO closure (grade 0 or 1 shunt) at 6-month BCTTE assessed by Corelab. Secondary endpoints included implantation success, complications, and atrial fibrillation during follow-up. Results 100 patients aged 43.8±11.5years, 53% male, were recruited. Indications for PFO closure included stroke (56%), TIA (29%) systemic embolism (4%) and MI (3%). Closure was undertaken under GA (44%) or LA (56%), with TOE (45%), ICE (31%), no imaging (20%) or TTE (3%). Balloon sizing was used in 98% of cases and showed a tunnel length of 7.3±3.6mm, primum-secundum separation of 7.0±2.9mm and basal inlet width of 8.5±3.5mm. Implantation was successful in all cases using 18mm (9%), 25mm (80%), 30mm (10%) and 35mm (1%) devices. 5 patients were lost to follow-up. 92 patients underwent six-month BCTTE. The primary endpoint of PFO closure (grade 0 or 1 shunt) at six months was 79.3%. One patient developed major bleeding (BARC 3b), one patient required vascular surgery, and in one patient device embolization was noted at six months and a larger device implanted. There was one case of new atrial fibrillation. Conclusions This first prospective monitored data for the Occlutech Figulla Flex II device demonstrates good safety and efficacy data at implant and six-month follow-up.

The first observation of the decay ηc(2S)→pp¯ is reported using proton-proton collision data corresponding to an integrated luminosity of 3.0fb−1 recorded by the LHCb experiment at centre-of-mass energies of 7 and 8 TeV. The ηc(2S) resonance is produced in the decay B+→[cc¯]K+. The product of branching fractions normalised to that for the J/ψ intermediate state, Rηc(2S), is measured to be Rηc(2S)≡B(B+→ηc(2S)K+)×B(ηc(2S)→pp¯)B(B+→J/ψK+)×B(J/ψ→pp¯)= (1.58±0.33±0.09)×10−2, where the first uncertainty is statistical and the second systematic. No signals for the decays B+→X(3872)(→pp¯)K+ and B+→ψ(3770)(→pp¯)K+ are seen, and the 95\% confidence level upper limits on their relative branching ratios are % found to be RX(3872)

The rapid Arctic summer sea ice reduction in the last decade has lead to debates in the maritime industries on the possibility of an increase in cargo transportation in the region. Average sailing times on the North Sea Route along the Siberian Coast have fallen from 20 days in the 1990s to 11 days in 2012–2013, attributed to easing sea ice conditions along the Siberian coast. However, the economic risk of exploiting the Arctic shipping routes is substantial. Here a detailed high-resolution projection of ocean and sea ice to the end of the 21st century forced with the RCP8.5 IPCC emission scenario is used to examine navigability of the Arctic sea routes. In summer, opening of large areas of the Arctic Ocean previously covered by pack ice to the wind and surface waves leads to Arctic pack ice cover evolving into the Marginal Ice Zone. The emerging state of the Arctic Ocean features more fragmented thinner sea ice, stronger winds, ocean currents and waves. By the mid 21st century, summer season sailing times along the route via the North Pole are estimated to be 13–17 days, which could make this route as fast as the North Sea Route.

Background The aim of this study was to evaluate the current standards of Fellowship training in Foot and Ankle Surgery Fellowship in the UK. Methods Thirteen UK post-FRCS (Tr&Orth) or equivalent Fellows completed a questionnaire detailing their outpatient, surgical, teaching and research experience, along with documenting their supervision and terms of employment. Results A Fellow attended a mean of 2.5 (0.5–4) clinics and 3.84 (2–7) theatre sessions per week. 62% of Fellows had independent clinics. The three largest sub-specialty areas experienced were forefoot surgery, mid or/hindfoot arthritis and deformity correction. 82% of Fellows had a regular MDT meeting. All were involved in both teaching and research, but only 64% had timetabled research sessions. All Fellows were satisfied with their experience and would recommended the Fellowship. Conclusions The current standard of a post FRCS (Tr&Orth) Fellowship in Foot & Ankle surgery in the UK has been defined. Further improvement will require all Fellows to be involved in a regular MDT meetings, work in an independent clinic, have guaranteed timetabled research time and a ring fenced study leave budget.

The objective of the paper is to review the works of several important scholars on cultural imperialism, neocolonialism and class struggle in Africa. In order to understand the forces of neo-colonialism and the class struggle in Africa along with the development of African consciousness and African Centered Thought, there must be a review of some of the most critical scholarship of African thinkers. To accomplish this objective we review the works of several widely read and appreciated scholars including: W.E.B. Du Bois who was a proponent of Pan-Africanism, Kwame Nkrumah and Frantz Fanon who maintained Pan-African and Marxist-socialist views, Julius Nyerere who was a Pan-Africanist and an African socialist, Jacob Carruthers who maintained African centered perspectives, Claude Ake who held both Marxist-socialist and African centered views, and Walter Rodney who held both a Pan-Africanist and Marxist-socialistic views.

Current approaches for measuring inequality are insufficient or unsuitable for promoting and designing equitable built environments and urban systems. In this paper, we demonstrate how a recently developed inequality measure—the Kolm-Pollak equally-distributed equivalent (EDE)—could be used to support decision making to foster equity in the built environment. The EDE provides a measure of a distribution that is similar to the average (mean) but includes a penalty based on the inequality of that distribution. The primary advantage of the Kolm-Pollak EDE is that it can be used to evaluate the inequality of both desirable quantities (e.g., amenities) and undesirable quantities (e.g., burdens). This is essential in urban systems as inequities can manifest through, among other things, disparate access to opportunities like public amenities and unequal exposure to burdens, such as pollution and natural hazards. Additionally, the Kolm-Pollak EDE can be calculated for different sociodemographic subgroups, enabling needs-based assessments to promote environmental justice. Thus, the Kolm-Pollak EDE presents numerous opportunities for practitioners, policymakers, and researchers concerned with advancing equity. We demonstrate the approach with a case study of grocery store access in ten cities across the USA and provide a Python package ( inequalipy ) and R code to enable others to use these inequality metrics.

Psychedelic drugs such as lysergic acid diethylamide (LSD) were used extensively in psychiatry in the past and their therapeutic potential is beginning to be re-examined today. Psychedelic psychotherapy typically involves a patient lying with their eyes-closed during peak drug effects, while listening to music and being supervised by trained psychotherapists. In this context, music is considered to be a key element in the therapeutic model; working in synergy with the drug to evoke therapeutically meaningful thoughts, emotions and imagery. The underlying mechanisms involved in this process have, however, never been formally investigated. Here we studied the interaction between LSD and music-listening on eyes-closed imagery by means of a placebo-controlled, functional magnetic resonance imaging (fMRI) study. Twelve healthy volunteers received intravenously administered LSD (75µg) and, on a separate occasion, placebo, before being scanned under eyes-closed resting conditions with and without music-listening. The parahippocampal cortex (PHC) has previously been linked with (1) music-evoked emotion, (2) the action of psychedelics, and (3) mental imagery. Imaging analyses therefore focused on changes in the connectivity profile of this particular structure. Results revealed increased PHC-visual cortex (VC) functional connectivity and PHC to VC information flow in the interaction between music and LSD. This latter result correlated positively with ratings of enhanced eyes-closed visual imagery, including imagery of an autobiographical nature. These findings suggest a plausible mechanism by which LSD works in combination with music listening to enhance certain subjective experiences that may be useful in a therapeutic context.

Equifinality—a situation in which multiple plausible explanations exist for a single outcome—presents a challenge for socio-environmental systems modeling. When equifinality is ignored in model calibration, subsequent policy analyses may mis-estimate the range of potential policy effects. In this paper, we present and demonstrate an approach—called DMC-RPA—for generating a set of diverse model calibrations (DMC) to enable more robust policy analysis (RPA). The optimization-based approach maximizes diversity in the model parameters and/or structural configurations to efficiently represent any equifinality in the model set. We demonstrate the approach for an agent-based model that is used to compare resilience-enhancing strategies in a smallholder farming system. Results over the set of diverse model calibrations demonstrate consistent policy effects, enabling stronger conclusions than a single model analysis. Going forward, this approach can be applied in the development of socio-environmental systems models to facilitate more robust policy analysis and inference.

Safety is an important dimension of access to green space. When parks are perceived as unsafe, people are unlikely to derive the health and community benefits from them. In this study, we examine inequities in green space access in five medium-to-large US cities using parcel-level, network-based analysis. We quantify access using three measures: proximity, congestion-weighted acreage, and crime-constrained proximity. We find that, in the five US cities studied, there is a striking lack of access to safe parks. In addition, inequalities between socioeconomic subgroups are substantially exacerbated when considering access to safe parks, with racial/ethnic minorities and low-income communities fairly consistently worse off. The results suggest that interventions to improve park safety could result in large and immediate improvements for access and environmental justice. However, even once these inequalities are addressed, there remains significant work to provide all residents with sufficient and proximal access to green space and the wide array of benefits that it has to offer.

Strategies aiming to increase the climate resilience of smallholder agricultural systems may not equally benefit all groups of the smallholder population. To reduce the potential for aggravating existing vulnerabilities, quantitative resilience analyses therefore need to acknowledge the possibility for inequities in the effects of proposed resilience-enhancing strategies (RESs). In this study, we develop, validate, and apply a household-level agent-based model to explore the equity of climate RESs in an Ethiopian smallholder farming system. Specifically, we study the potential effects of two RESs, involving access to seasonal climate forecasts and increases in non-farm job availability, on household food security under climate variability. We measure these effects in two distinct ways: “poverty-reduction,” which describes food security improvements relative to existing conditions; and “shock-absorption,” which isolates the strategies' effects on food security during and following a drought. Our results reveal that the different measures of resilience lead to divergent assessments of equity in policy effects. Relative to baseline levels of food security (poverty-reduction), both strategies disproportionately favor the most vulnerable households—i.e., they are equity-enhancing. Under this assessment, increases in job availability provide slightly stronger benefits to the most vulnerable households than climate forecasts. However, when isolating the effect of a drought (shock-absorption), both RESs benefit the moderately vulnerable households at the expense of the more vulnerable households—i.e., they are inequitable. These results demonstrate that a pure focus on poverty reduction may be insufficient to promote equitable development. Given the prevalence of climate shocks in smallholder systems, future studies of resilience should therefore jointly consider both poverty reduction and shock recovery, as well as the potential for inequity in the effects of RESs.

This paper will analyze the scholarly works and ideals of Black feminist, feminist, womanist, Pan Africanist, and Africana womanist thinkers to address the progress of Black feminism, womanism, Africana womanism, sexism, racism, and Afrofuturism. To address racism, sexism must be addressed first to challenge the structures of power to pursue equality and equity for all. Through the systematic lens of Black feminism, womanism, Africana womanism, and Afrofuturism will help with approaches to challenge the sexism and racism that dwells in our culture and society. Many academic scholars have added to the foundation of Black feminism, womanism, Africana womanism, and Afrofuturism that have been overlooked by the hegemonic culture. The paper will analyze those academic works from Maria Stewart, Angela Davis, Anna Julia Cooper, Alice Walker, Betty Friedan, bell hooks, Elizabeth Spelman, Kimberle Crenshaw, Sandra Harding, Clenora-Hudson Weems, Chikwenye Okonjo Ogunyemi, Marie Pauline Eboh, and Patricia Hill Collins, who have added to the advancement of Black feminism, womanism, Africana womanism, and Afrofuturism. Afrofuturism was established with the ideas, ideals, minds, writings, thoughts, actions, and experiences of the women in the Africa/ African Diaspora. Afrofuturism is a philosophy that discovers the art and beauty of the African/ African diaspora. Also, is used to create a world the has a space and time for black bodies to live within their culture. Womanhood is Afrofuturism. By this definition, the feminist outline has engulfed different issues ranging from political rights to educational opportunities within a worldwide setting. The Black feminist plan is determined to make headway on these issues and concentrations on those that are priority to African-American women. According to Patricia Hill Collins, Black feminism: “… is a thought stating that sexism, class oppression, gender identity and racism are inextricably bound together.” These terms mentioned above are grouped together to form a concept called intersectionality, which was introduced by a legal scholar, Kimberle Crenshaw in 1989. Crenshaw discussed in her that Black feminism, contests the experience of being a black woman who cannot be understood in terms of being black or of being a woman. On the other hand, each concept should be understood separately while maintaining the experiences that occur to establish each other. Activist and author Angela Davis was one of the first people to organize an argument on intersectionality from her book, Women, Race, and Class (1981). Anna Julia Cooper added that black feminism is necessary, because: “the vital agency of womanhood in the regeneration and progress of a race, as a general question is conceded almost before it is fairly stated. I confess one of the difficulties for me in the subject assigned lay in its obviousness. The plea is taken away by the opposite attorney’s granting the whole question.” By examining the ideals and theories of black feminist thought in race and power, there will be a connection made between the works of black feminist authors, womanist thinkers, Pan African thinkers, and Africana woman thinkers who have relevance in Black feminism. Black feminism, womanism, and Africana womanism allows for examination of sexism and racism that is deeply-rooted in the institutions and systems of American society. In the speech, “Ain’t I a Woman” (1851), Sojourner Truth discussed sexism and racism in the statement: “…I am a woman’s rights. I have as much muscle as any man, and can do as much as any man. …I have heard much about the sexes being equal; I can carry as much as any man, and can eat as much too, if I can get it. I am strong as any man that is now. As for intellect, all I can say is, if women have a pint and man a quart- why can’t she have her little pint full? You need not be afraid to give us our rights for fear we will take too much, for we can’t take more than pint’ll hold. Through God who created him and woman who bore him. Man, where is your part?” The institutional sexism and racism are forceful in the hegemonic culture. Black feminism, womanism, Africana womanism, and Afrofuturism is used as a systematic lens to examine existing power structures. The theory analyzes these power structures which are based on white privileged and white supremacy and sustains alienate people of color. Ultimately, Black feminism, womanism, Africana womanism, and Afrofuturism critically examines society and culture through the scopes of race, law and power.

In this paper, the objectives and mission of AFRICOM will be examined in comparison to its actual practices to assess the true nature of its presence in Africa and its impact on the class struggle of Africans. To fully understand the interest of the United States in Africa; US foreign policy, and the establishment of United States’ Africa Command (AFRICOM), one must examine these concepts for understanding. Discussing the history of the United States capabilities, intentions and motivations is necessary for insight for interpreting the past, present, and future of Africa and its’ relationship with the US. This research will help examine if AFRICOM is an instrument of US foreign policy in the form of neo-colonialism or diplomacy and the impact to the class struggle to Africans. Kwame Nkrumah stated that neo-colonialism: “…is a greater danger to independent countries than is colonialism. …In neo-colonialism, however, the people are divided from their leaders and, instead of providing true leadership and guidance which is informed at every point by the ideal of the general welfare, leaders come to neglect the very people who put them in power and incautiously become instruments of suppression on behalf of the neo-colonialism.” Also, this paper will offer insight on if the interests of Africans and African Americans are really served by Africans. Peter Pham’s research concluded that AFRICOM has been viewed by some policymakers and commentators as a US foreign policy used to colonize Africa. Tsenay Serequeberhan concluded that the United States is plays apart in neo-colonialism. He stated: “Today, in the last decade of the twentieth century, the United States is the dominant superpower and the harbinger of a new ‘new world order’ dominated by the West (i.e., NATO). In fact, paraphrasing Lenin and Nkrumah, one could describe this ‘new world order’ as the latest, if not the highest, stage of neocolonialism in which the United States, under the guise of the United Nations, rules the world, and smart bombs enforce ‘international law’.” AFRICOM should be examined and analyzed to see if the mission of AFRICOM is meeting its objectives. Concluded by Peter Pham, AFRICOM was established to “bring peace and security to the people of Africa and promote US common goals of development, health, education, democracy and economic growth in Africa by strengthening bilateral and multilateral security of cooperation with African states and creating new opportunities to uplift their capabilities.” From Pham’s research, there are concerns from the people of Africa and within the United States that the interest of Africa is not the same under AFRICOM. To know if AFRICOM is an instrument of US foreign policy, one must analyze the US foreign policies of post-colonial United States administration with Africa and the interest in Africa to find patterns, trends, and underlying economic interests. The theoretical framework of which this research will be analyze through is the theories of power elite and dependency. The power elite theory is used as a lens to examine the interactions between Africa and its’ people and individuals of business, government, and military who are powerful and influential to make decisions concerning Africa’s cultural, economic and social well-being. The dependency theory will help explain the how developing nations, such as Africa are economically exploited by advanced nations, such as the United States. The theories will help gain insight into AFRICOM, to understand its’ true intentions and motives with Africa and its’ people. In order to understand the purpose of class struggle, and its’ connection to Africa, the history and intent must be analyzed and examined. The class struggle will be viewed through the lens of Karl Marx, Pierre Bourdieu, Kwame Nkrumah, W. E. B. Du Bois, Jacob Carruthers, Julius Nyerere, Frantz Fanon, Ali Mazrui, Claude Ake, and Chairman Mao Tsetung.

A search for time-integrated CP violation in the Cabibbo-suppressed decay D-0 -> pi(+)pi(-)pi(+)pi(-) is performed using an unbinned, model-independent technique known as the energy test. This is the first application of the energy test in four-body decays. The search is performed for P-even CP asymmetries and, for the first time, is extended to probe the P-odd case. Using proton proton collision data corresponding to an integrated luminosity of 3.0 fb(-1) collected by the LHCb detector at centre-of-mass energies of root s = 7 TeV and 8 TeV, the world's best sensitivity to CP violation in this decay is obtained. The data are found to be consistent with the hypothesis of CP symmetry with a p-value of (4.6 +/- 0.5)% in the P-even case, and marginally consistent with a p-value of (0.6 +/- 0.2)% in the P-odd case, corresponding to a significance for CP non -conservation of 2.7 standard deviations. (C) 2017 The Author(s). Published by Elsevier B.V.

A wave-ice interaction model for the marginal ice zone (MIZ) is reported that calculates the attenuation of ocean surface waves by sea ice and the concomitant breaking of the ice into smaller floes by the waves. Physical issues are highlighted that must be considered when ice breakage and wave attenuation are embedded in a numerical wave model or an ice/ocean model. The theoretical foundations of the model are introduced in this paper, forming the first of a two-part series. The wave spectrum is transported through the ice-covered ocean according to the wave energy balance equation, which includes a term to parameterize the wave dissipation that arises from the presence of the ice cover. The rate of attenuation is calculated using a thin-elastic-plate scattering model and a probabilistic approach is used to derive a breaking criterion in terms of the significant strain. This determines if the local wave field is sufficient to break the ice cover. An estimate of the maximum allowable floe size when ice breakage occurs is used as a parameter in a floe size distribution model, and the MIZ is defined in the model as the area of broken ice cover. Key uncertainties in the model are discussed.

The theoretical foundation of a wave–ice interaction model is reported in Part 1 of this study. The model incorporates attenuation of ocean surface waves by sea ice floes and the concomitant breaking of the floes by waves that determines the structure of the marginal ice zone (MIZ). A numerical implementation of the method is presented here. Convergence of the numerical method is demonstrated, as temporal and spatial grids are refined. A semi-analytical method, which does not require time-stepping, is also developed to validate the numerical results, when dispersion is neglected. The wave energy lost during ice breakage is parameterized, as part of the numerical method. Sensitivity studies are conducted in relation to the energy loss and also dispersive effects, the choice of the attenuation model, the properties of the wave field, and sea ice properties such as concentration, thickness and breaking strain. Example simulations intended to represent conditions in the Fram Strait in 2007, which exploit reanalyzed wave and ice model data, are shown to conclude the results section. These are compared to estimates of MIZ widths based on a concentration criteria, and obtained from remotely-sensed passive microwave images.

Why do genocides occur? This paper applies qualitative comparative analysis (QCA) to revisit this question, and analyses 139 cases of genocide and non-genocide. The paper demonstrates the importance of both priming, contextual conditions which provide a political opportunity structure conducive to genocide, as well as triggering, more proximate conditions which constitute immanent motivations. Most centrally, sufficiency is demonstrated for genocide occurrence when an autocratic regime and the salience of an elite's ethnicity are present, and are combined with either an exclusionary ideology or political upheaval. As such, the autocratic nature of the state provides an opportunity structure allowing genocide to occur, while the salience of elite ethnicity can serve as a motivation. Finally, the ideology and the political upheaval serve as an additional motivation or opportunity structure, respectively. While political upheaval can play a part in causing genocide, its role is much more understated than is suggested in previous literature.

In the recent past, U.S. courts have begun to require that litigating parties base patent infringement damages on sales of the “smallest salable patent-practicing unit,” or SSPPU, in an effort to constrain the patentee’s damages claim to the true “economic footprint” of the invention. We ask whether this legal requirement can be grounded in economic theory, industry licensing practices, or the scope of actual patent claims. We find significant theoretical reasons to reject the mandatory imposition of the SSPPU rule, because the economic impact of an invention is not, in general, limited to the sales price of an input that allegedly embodies it. In the telecommunications industry, where the SSPPU rule has assumed additional policy significance in the context of FRAND commitments by owners of standard-essential patents (SEPs), we find overwhelming evidence that: (1) major licensors and licensees reject the ostensible SSPPU — the baseband processor — as a royalty metering device, regardless of their place in the supply chain; and (2) for one representative patent portfolio, the scope of the claims cannot be limited to the baseband processor itself. In short, we find that the pricing of telecommunications inventions is not limited to the “smallest” component, nor are such components necessarily “salable,” or “patent-practicing.”

Obscure pain around the foot and ankle can be notoriously difficult to localise. Anatomical imaging studies will often require supporting evidence from functional scintigraphic studies in the more difficult cases. Single photon emission computerised tomography-computed tomography (SPECT-CT) is a novel technique combining these two studies instantaneously in a single scan. We present six cases from our ongoing experience with SPECT-CT. Caution in the use of SPEC-CT is suggested by one of these cases. Five cases extol the virtues we perceive of the technique whilst the sixth presents a note of caution. Our findings are supported in the current literature and serve to refine the place for this emerging imaging technique.

This paper is inspired by the proposition that it may be possible to extract descriptive physical parameters – in particular the ice thickness, of a sea-ice field from ocean wave information. The motivation is that mathematical theory describing wave propagation in such media has reached a point where the inherent heterogeneity, expressed as pressure ridge keels and sails, leads, thickness variations and changes of material property and draught, can be fully assimilated exactly or through approximations whose limitations are understood. On the basis that leads have the major wave scattering effect for most sea-ice [Williams, T.D., Squire, V.A., 2004. Oblique scattering of plane flexural-gravity waves by heterogeneities in sea ice. Proc. R. Soc. Lon. Ser.-A 460 (2052), 3469–3497], a model two dimensional sea-ice sheet composed of a large number of such features, randomly dispersed, is constructed. The wide spacing approximation is used to predict how wave trains of different period will be affected, after first establishing that this produces results that are very close to the exact solution. Like Kohout and Meylan [Kohout, A.L., Meylan, M.H., 2008. An elastic plate model for wave attenuation and ice floe breaking in the marginal ice zone. J. Geophys. Res. 113, C09016, doi:10.1029/2007JC004434 ], we find that on average the magnitude of a wave transmitted by a field of leads decays exponentially with the number of leads. Then, by fitting a curve based on this assumption to the data, the thickness of the ice sheet is obtained. The attenuation coefficient can always be calculated numerically by ensemble averaging but in some cases more rapidly computed approximations work extremely well. Moreover, it is found that the underlying thickness can be determined to good accuracy by the method as long as Archimedean draught is correctly provided for, suggesting that waves can indeed be effective as a remote sensing agent to measure ice thickness in areas where pressure ridges are not sizeable, i.e. away from coastal regions of high deformation.

This paper considers the reflection and transmission of a flexural-gravity wave within ice sheets floating on water as it propagates through a series of abrupt changes in ice sheet characteristics. The canonical problem involves one such junction at which two semi-infinite ice sheets of different properties are either frozen together or separated by a crack. Unlike most mathematical approaches to problems involving ice sheets, we allow the ice sheets to adopt a variable submergence according to their thickness. The problem is solved using integral equations formulated through the matching of eigenfunction expansions.

The sole, Solea senegalensis, is a common flatfish of Atlantic and Mediterranean waters with a high potential for aquaculture. However, its cultivation is hampered by high sensitivity to different stresses and several infectious diseases. Improving protection from pathogens and stressors is thus a key step in reaching a standardized production. Fish were exposed to lipopolysaccharide (LPS), a mimetic of bacterial infections, and copper sulphate (CuSO(4)), used in aquaculture to control algae and outbreaks of infectious diseases. We employed a European flounder cDNA microarray to determine the transcriptomic responses of Senegalese sole to these exposures. Microarray analyses showed that many genes were altered in expression following both LPS and copper treatments in comparison to vehicle controls. Gene ontology analysis highlighted copper-specific induction of genes related to cellular adhesion and cell signalling, LPS-specific induction of genes related to the immune response, and a common induction of genes related to unfolded protein binding, intracellular transport/secretion and proteasome. Additionally transcripts for glutathione-S-transferases were down-regulated by LPS, and those for digestive enzymes were down-regulated by both treatments. We selected nine changing genes for absolute quantification of transcript copy numbers by real-time RT-PCR to validate microarray differential expression and to assess inter-individual variability in individual fishes. The quantitative RT-PCR data correlated highly with the microarray results. Overall, data reported provide novel insights into the molecular pathways that could mediate the immune and heavy metal stress responses in Senegalese sole and thus might have biotechnological applications in the culture of this important fish species.

We evaluated the effects of two putative non-genotoxic hepatic carcinogens, hexabromocyclododecane (HBCD) and 17-beta oestradiol (E(2)) on global and CpG promoter DNA methylation in both primary human hepatocytes and hepatocellular carcinoma (HepG2) cells. The mRNA gene expression levels of genes involved particularly in cell cycle were also evaluated and potential correlation with DNA methylation status examined. HBCD at 0.03 and 0.3 ng/mL did not produce statistically significant differences in global genomic methylation. However, E(2) (0.1 ng/mL) significantly lowered global DNA methylation levels in HepG2 cells by approximately 65% (P

Williams and Squire (Williams, T.D., Squire, V.A., in press. The effect of submergence on wave scattering across a transition between two floating flexible plates. Wave Motion) present a mathematical theory that properly incorporates freeboard and draft, i.e. submergence, in a description of how ocean surface waves propagate across an abrupt change of properties in a continuous sea-ice cover. Typically the abrupt feature is an ice floe of different thickness from the surrounding plate, a trapped iceberg, a pressure ridge, or an open or refrozen lead. Here, we investigate how the assimilation of this floe submergence into theory alters the transmission of the wave trains, allowing the approximation and consequent limitations inherent in the majority of previous models that apply the under-ice boundary conditions at the mean open water surface to be assessed. This is done for isolated features and, using the wide-spacing approximation, for heterogeneous ice sheets made up of many such irregularities drawn from appropriate probability density distributions. It is found that the contribution associated with the underwater draft of ice floes is modest and can invariably be neglected, aside from at short periods and in heavily deformed sea-ice. While its amassed effect across the many irregular features that habitually characterize sea-ice will be significant, it is offset because of the tendency of ice covers to discourage the passage of short wavelengths preferentially by creating a background wave spectrum composed only of long period wave energy in the ice interior. More general geophysical implications are discussed, particularly in relation to global climate change and the value of ice-covered regions as a proxy for observing a warmer Earth.

The reflection and transmission of flexural-gravity waves at a sudden change of properties of finite extent, e.g., an irregularity such as an entrapped iceberg, in an otherwise uniform sea-ice sheet is considered theoretically. Although similar in purpose to Squire and Dixon [V.A. Squire, T.W. Dixon, On modelling an iceberg embedded in shore fast sea ice, J. Eng. Math. 40 (3) (2001) 211–236], the current paper correctly incorporates changes of Archimedean draft, i.e., submergence, between the three adjoining plates and thereby allows the approximations in that work to be examined and quantified. This is unusual, as the bulk of the published work concerned with wave propagation beneath floating ice sheets ignores the effects of submergence on the basis that the wavelengths involved significantly exceed the ice thickness and hence the draft of the sheet. After validation, results are presented showing how the reflection coefficient depends on the geometry of the arrangement being modelled, including both isolated floes in the open sea, which may surge, and ice floes and bergs surrounded by a contiguous uninterrupted ice sheet. The effect of draft is investigated and a wide spacing approximation is also developed that allows the scattering coefficients for the boundary between two floating semi-infinite sheets to be deduced when submergence is included. This also enables us to approximate the scattering by a lead.

Dissimilar imperfections such as cracks and pressure ridges in sea ice result in similar reflection coefficients when they scatter ice-coupled waves, being highly reflective at short wavelengths, highly transmissive at long wavelengths, and having some periods at which transmission is perfect (although associated with a change in phase). The causes of the zeroes in the reflection coefficient are not well understood and where analytic solutions can be found physical interpretations are difficult. Here we examine simplified systems that are amenable to such an interpretation. For a single crack in an ice sheet we present an asymptotic solution for a very thin sheet and furnish a new interpretation of the existing wide-spacing approximation that suggests that the zero is caused by destructive interference of waves reflected from each of the two sides of the crack. For a simple rectangular pressure ridge we report a small feature approximation that also shows that the zero arises from destructive interference but, for this case, interference of waves reflected from the mass and rigidity of the ridge.

Background It is unclear whether late outcome differs for Marfan syndrome and marfanoid patients. Thus, we compared characteristics of Marfan versus marfanoid patients and their survival and requirement for reoperation. Methods From 1978 to October 2003, 162 patients with a presumptive diagnosis of Marfan syndrome underwent operation. We recategorized them as confirmed Marfan (n = 122), marfanoid (n = 23), Ehlers-Danlos syndrome (n = 5), or other (n = 12). Patients categorized as marfanoid failed to meet the major criteria of Marfan syndrome. We compared characteristics of Marfan and marfanoid groups and assessed long-term survival and need for reoperation. Results Marfan and marfanoid patients had similar demographics (women, 33% versus 39%; age, 39 ± 13 versus 41 ± 12 years; height, 186 ± 12 cm versus 184 ± 9.6 cm), valve pathophysiology (aortic regurgitation, 66% versus 58%; mitral regurgitation, 58% versus 62%), and aortic pathology (dilated, 40% versus 39%; dissected, 17% versus 13%). Overall hospital survival was 99.3% (144/145), and 10-year survival was similar at 82% in the Marfan and 100% in marfanoid groups ( p = 0.13). Patients with aortic dissection ( p = 0.001) and mitral valve replacement ( p = 0.003) were at higher risk of death. Reoperation was more frequent after separate aortic valve–ascending aorta graft operations ( p = 0.04), and among taller patients ( p = 0.005). Of 24 Marfan patients with David root reimplantations, none has required reoperation. Conclusions Marfan and marfanoid patients have similar physical characteristics and postoperative survival, although reoperation was more frequent in Marfan patients. Surgery before occurrence of aortic dissection or mitral valve repair should reduce the risk of reoperation, but taller patients, irrespective of Marfan or gender, are more likely to require reoperation.

In the case of Freddie Gray, certain standards of operation, practices, and policies set by the law enforcement administration for the Baltimore Police Department was not followed. The issue of the cause of death needs to be examined. As observed in the review of literature, the police officers misinterpreted what the reasonable amount of force is and abused their authority which ended up costing a young man’s life. To minimize the arrest-related deaths in police custody, there needs to be advice on the use of force policy to protect both the officer and suspect. Also, in the Baltimore Police Department and police departments worldwide there should be a push to enforce accountability and supervision among the ranks of officers. By doing this ensures that the standards of operation, practices, and policies are enforced daily to promote the mission of each department. Enforcing accountability will allow officers to meet the needs of the citizens that they are there to protect and serve them.

Mitral valve (MV) annuloplasty is the standard surgical technique for the management of ischemic mitral regurgitation (MR). However,or = 1/3 of patients develop recurrent MR after annuloplasty. Therefore, we sought to identify the preoperative echocardiographic parameters that predict annuloplasty failure in patients with ischemic MR. Intraoperative transesophageal echocardiograms from 365 patients who underwent MV repair for ischemic MR were reviewed. Of the 365 patients, 297 (81%) had satisfactory outcomes with2+ MR, and 68 (19%) had recurrent MR (or = 2+) during a mean follow-up of 269 days. The mitral annular parameters, including mitral annular diameter, tethering height, and tethering area of the mitral leaflets, were determined in 3 different echocardiographic views. On multiple logistic stepwise regression analysis, a higher mitral annular diameter, higher tethering area, and higher MR severity were identified as independent predictors for failure of MV repair (p0.0001). In conclusion, these results demonstrated that preoperative echocardiographic findings can be used to identify patients with ischemic MR at increased risk of repair failure. These echocardiographic measurements should be used to guide the cardiologist and cardiac surgeon in the choice of MV repair versus replacement in patients with ischemic MR.

The induction of hepatic cytochrome P450 1A (CYP 1A) is an important step in the response to contaminants such as polycyclic aromatic hydrocarbons (PAHs), and has been used as a biomarker of exposure in fish. Several consensus response elements have been identified, including eight potential xenobiotic response elements (XREs) in the promoter region of the European flounder cytochrome P450 1A gene. However not all of these sequences are necessarily active. To help elucidate the molecular regulation of this important gene, site directed mutagenesis and dual-luciferase reporter gene assays were employed to characterize the consensus transcription factor binding sites of the CYP 1A 5′ flanking region. Mutation of response elements situated −1103, −859, −709 and −172 bases upstream of the transcription start site reduced the induction to 2.75, 1.51, 3.25 and 3.05 fold, respectively, compared with the full-length promoter (4.0-fold induction) on exposure to the PAH 3-methylcholanthrene (3MC) (1.0 μM). These results indicate that four out of eight different XREs are functional in the control of CYP 1A in the flounder. The activity of these response elements adds to the evidence for considerable diversity in vertebrate CYP 1A regulation.

Luminex Single Antigen Beads Assay (SAB) are currently the most widely used means to identify HLA antibodies in sera from sensitized transplant candidates. Although these assays greatly enhance solid organ transplantation practices in terms of transplantig highly sensitized patients and the ability to perform virtual (electronic) crossmatch, issues concerning identifying unusual patterns or reactivity in some patients have emerged. This unusual pattern can be seen in male non-sensitized patients, patients with underlying auto-immune diseases, and normally sensitized patients. In order to investigate this pattern further, our lab utilized two primary testing platform. The One Lambda SAB Class I and Class II, was utilized as our primary testing patform. The LifeCodes SAB Class I and Class II was used as the secondary testing platform. Patterns of unusual reactivity were also examined by performing a flow cytometry crossmatch with surrogate donors. As control group, sera from 40 sensitized and non-sensitized patients were utilized to perfom the initial comparative study. Our results showed the HLA antibodies pattern of reactivity were identical between the two platforms. For patients with unusual HLA antibodies patterns, there was minimal correlation between the two platforms. False positive patterns identified by One Lambda SAB assays, were re-tested with LifeCodes SAB assays and results either in none or completely different false positive reactive patterns (see graph below). The absence of correlation between the two testing platforms in terms of false positive patterns might suggest that the patterns of reactivity might be directed to non-HLA IgG. In order to address that, we performed total IgG purification from two sera with this false positive pattern utilizing Protein A magnetic beads. SAB assay performed on purified IgG fraction eluted from the beads resulted in significant increase in the MFI values of these samples without any effect on the reactivity. In conclusion, interefence in SAB assays could be due to IgG fraction. Additional studies utilizing further blocking might be needed to eliminate this interfering patterns. Download : Download high-res image (237KB) Download : Download full-size image

The development and installation of susta13inable energy systems create jobs, regional development, and long term economic growth. The challenges presented by sustainable urban development are critical. Back in 2010, 82% of Americans lived in cities; by 2050 it will be 90 %. Cities are responsible for around two-thirds of the energy used, 60% of all water consumed, and 70% of all greenhouse gases produced worldwide. Sustainable cities are looking at ways to become more environmentally friendly, increase the quality of life for their residents, and cut costs at the same time.

For comparative purposes, the toxicity of cadmium, hexavalent chromium and copper to marine fish larvae (Cyprinodon variegatus) and copepods (Tisbe battagliai) has been evaluated. Toxicity to fish larvae was measured in terms of survival and growth over 7 days, whilst toxicity to copepods was assessed in terms of survival and reproduction after 8 days exposure. For fish larvae, 96 h LC50 values (based on mean measured concentrations of total metal ion) were 1.23 mg Cd/litre, 31.6 mg Cr6+/litre and >0.22 mg Cu/litre. Subchronic values (SChVs) for larval fish survival and growth after 7 days were 0.75 mg Cd/litre, 24.0 mg Cr6+/litre and 0.16 mg Cu/litre. For copepod nauplii and adults, 96 h LC50 values were as follows: 0.46 mg Cd/litre and 0.34 mg Cd/litre, respectively; 1.60 Cr6+/litre, and 5.9 mg Cr6+/litre respectively; and 0.064 mg Cu/litre and 0.088 mg Cu/litre, respectively. SChVs for naupliar survival and adult survival or reproduction after 8 days were 0.024 mg Cd/litre, 0.42 mg Cr6+/litre and 0.008 mg Cu/litre.

Aim The increasing volume of tests (∼5% growth per year) processed by the Histocompatibility laboratory has gradually become an overwhelming challenge. The current Laboratory Information System (LIS) Oracle database has generated a substantial amount of manual and redundant data entry while only offering limited interface capabilities without meeting the changing regulatory reporting requirements. This manual input has contributed to inefficiency and transcription errors while lack of interfaces has significantly increased the paperwork. In 2011, the decision was made to implement a replacement LIS to address these issues. Methods The HistoTrac software available from SystemLink was chosen to meet our needs. Workflow considerations were subsequently made with strategies developed for maintaining an existing information system while implementing its replacement. A detailed timeline with major milestones and their estimated durations was established to monitor progress with support from the vendor. The laboratory IT team performed all major data migration, software upgrades and interface development as well as testing, validation and training. After going live in May 2012, the cost savings and improvement in Turn Around Time (TAT) have been closely monitored. Results External databases and most laboratory equipment were integrated with HistoTrac to support a seamless data transfer and reduce manual transcription. Middleware (i.e. Excel macros) were developed to format data exported from HistoTrac specifically to fit instrument requirements. Significant cost savings in all areas of the laboratory ($93,000) was realized. The TAT was improved on average by a day for both High and Mediums resolution HLA typing tests. Conclusions A well designed cost-effective information system is essential for a laboratory to stay competitive. The new LIS dramatically reduced the clerical labor required to handle information, increased the accuracy of patient reports, and significantly sped up reporting of results to providers. The connection of automated instruments to the LIS is perhaps the most important aspect of the system. Without these bi-directional interfaces, the system will not be fully functional.

Aim Analysis of the single antigen bead (SAB) assay is frequently complicated by the presence of recurrent background patterns (BP), likely due to non-HLA antibodies cross-reacting with cryptic epitopes on denatured HLA molecules. We investigated whether this BP are less frequently detected by an assay with reduced amount of denatured antigens (iBeads). Methods Ninety-six serum samples from The University of Michigan Transplant Center tested between 4/2012 and 4/2013 were analyzed comparing iBeads with SAB. iBeads was considered successful when the BP present in SAB was absent in this assay. Individual pattern frequency was examined as well. Results Side-by-side comparison revealed that for 60% (n=58) of the samples, iBeads did not detect the non-specific BP shown by SAB assay. The same BP were encountered with both assays in 34% (n=33) of the samples, and were partially reduced in 6% (n=5) in iBeads. Certain BP were frequently undetected by iBeads. Among them, the Broad Cw pattern was the most frequent pattern seen by SAB (n=19) and undetected by iBeads in 95% (n=18). The BP A1/36, A68 (A∗68:02), and B8 were not detected by iBeads in 100% (n=7), whereas the pattern involving B45 was still found on iBeads. Other commonly detected patterns, such as B44, B76, B82, Cw1,12,15, Cw17 and others, were detected in some samples by iBeads and not in others.[Fig. 1] Conclusions iBeads assay performance appears to be better than the SAB assay on samples with non-HLA antibodies cross-reacting with cryptic epitopes of denatured HLA molecules. Persistent BP may be in relation to the concentration of interference or other samples characteristics as yet unknown. [figure1]

Aim We have previously reported the development of very high resolution (VHR) HLA genotyping, designed to resolve the majority of both the “common and well documented alleles” and the null alleles using the 454 GS FLX Sequencing System and Conexio genotyping software. Amplicon library construction was performed using 22 PCR fusion primers, containing genome target specific sequence with 454 sequencing adaptors. The VHR assay performed well but required extensive handling of individual amplicons. To simplify the workflow, we prepared the amplicon libraries by three alternative procedures. Methods PCR amplicons were generated from 10 cell lines for: HLA-A/B exons 1-5, HLA-C exons 1-7 and some intronic class I regions; DPA1, DPB1, DQA1 exon 2; and DQB1, DRB exons 2 and 3. Amplification required 22 pairs of fusion primers (14 primer pairs in the GS GType HLA primers plates from 454, plus 8 amplicons in a third plate) with 10 Multiplex Identifiers (MIDs), or 22 primer pairs each containing, at the 5′end, a universal sequence which matched the 3′ end of a set of primers that contained 10 MIDs and the 454 sequencing adaptors. Amplicons derived from fusion primers were purified, quantified, diluted to a standard concentration, then pooled OR pooled prior to the other operations. Amplicons generated by the four primer system on the Fluidigm Access Array™ were handled by the latter procedure. Pools of amplicons were sequenced on the GS FLX and genotyped with Conexio software. Results All three procedures resulted in comparable genotyping (concordance up to >98%). Pooling amplicons immediately following the genomic PCR gave a reduction in the number of pipetting steps necessary to produce an amplicon library by ∼80% and ∼90% using fusion primers and the four primer system, respectively. Conclusions Pooling amplicons early in the 454 library preparation procedure greatly simplifies the workflow of the 22 primer VHR HLA genotyping assay for fusion primers as well as the 4 primer system. Holcomb: Roche: Employee. Hoglund: Roche: Employee. Williams: Roche: Grant Research. Erlich: Roche: Employee.

Aim Genotyping of DRB1 and DRB3/4/5 is performed in our lab using generic DRB PCR primers, followed by sequencing on the 454 GS FLX and use of Conexio Genomics software. During genotyping homozygous cell lines, we detected additional sequences at about 7% of the read depth of the reported true allele. These artifacts appeared to be PCR crossovers between the DRB1 and DRB3/4/5 sequences. The crossovers usually had one or more mismatches with the IMGT database but occasionally matched a very rare allele (e.g. DRB1 ∗ 03:42). We performed a study to determine if these sequences were in vitro artifacts and to determine if some rare DRB alleles in the IMGT database might, in fact, be in vitro artifacts that had been submitted. Methods To test for in vitro artifact formation during late cycles of genomic PCR, we amplified the DRB loci from 21 homozygous cells lines under both our standard PCR conditions (35 cycles) and a reduced number of cycles (28), followed by 454 sequencing. Using the same PCR conditions, we also sequenced the DRB loci of four samples, each of which had previously been identified as having a novel DRB allele that was subsequently submitted to the IMGT database. Results For all homozygous 21 cell lines, amplification for 35 cycles gave low abundance sequences as possible “second alleles.” In 36% of the cases, these artifactual sequences corresponded to named alleles. Such sequences were not detected with amplification for 28 cycles. In the case of 4 samples with rare alleles previously submitted to the IMGT, we found that 3 were true alleles. The fourth, while not a crossover product, contained a sequencing error which was revealed by our 454 HLA genotyping assay. Conclusions Formation of in vitro crossover products of the DRB loci can occur in late cycles of PCR. PCR conditions have been identified that minimize generation of these in vitro artifacts. Clonal sequencing on the 454 GS FLX is a valuable method for revealing both these artifacts and traditional sequencing errors.

Aim The association between HLA-DQ Donor Specific Antigen (DSA) and chronic antibody mediated rejection (AMR) has been reported in several cohort studies, and anti-DQ is the most frequent detected DSA after solid organ transplantation. Unlike Class I or HLA-DR DSA, anti-DQ DSA show little improvement with current antibody removal protocols as demonstrated by persistently elevated IgG Mean Fluorescent Intensity (MFI) values (MFI > 7000). Here we compare IgG and C1q single antigen measurements to monitor the response to antibody removal therapy. Methods Post transplant de novo anti-DQ DSA in one kidney and one lung recipient were tested by single antigen IgG and C1q binding assay (One Lambda). Samples were collected before, during and after antibody removal treatment with plasmapheresis and IVIG. Results were correlated with organ function by creatinine level and FEV1 in the kidney and lung recipients, respectively. Results Changes in IgG and C1q MFI measurements during treatment are represented in the Table 1 and Fig. 1. Both patients IgG levels remain over MFI > 10,000 after treatment. In contrast, the values of C1q show a decline with treatment that correlates with improving creatinine in the kidney recipient. FEV1appears to stabilize when the C1q MFI is Download : Download full-size image Conclusions Based on these results, C1q MFI measurements is superior to IgG MFI monitoring during antibody removal therapy to reduce anti–DQ DSA. The combination of these two assays may improve the characterization and the management of AMR due to anti-DQ DSA.

Aim The contribution of MICA antibodies to AMR and poor transplant outcomes have been described by multiple reports. In order to implement the MICA antibody assay screening in our transplant algorithm we evaluated the MICA sensitization status in our patient population. Methods We collected MICA antibody results from a group of 205 previously transplanted patients: 168 kidney transplants, 28 heart recipients and 9 lungs recipients. As a control we collected MICA antibody results from a group of 100 patients waiting for the first renal transplant. Antibody MICA detection was initially screened with LABScreen ® Mixed (One Lambda), and positive results were confirmed by MICA LABScreen ® singe antigen assay (One Lambda). Results As expected, the frequency of anti MICA antibody was higher in the previously transplanted patients when compared with the control group. We found anti-MICA in 21 (10.2%) transplanted patients vs. 3 (3%) in the control group. When we divided the transplanted group by organ type, we found anti-MICA antibodies in 10.1% of the kidney-transplanted patients, 14% of the heart-transplanted patients and 0% of the lung-transplanted patients. See Table 1 . Conclusions The frequency of anti-MICA antibodies was considerably higher in the group of previously transplanted patients. MICA typing information and Anti-MICA antibody results will help in the selection and management of patients receiving a kidney from a living donor, and improve the post-transplant management of patients receiving organs from deceased donors.

ObjectivesThe present study examined the relationship between hospital and surgeon coronary artery bypass grafting procedural volume, mortality, morbidity, and National Quality Forum care processes in a university-based community hospital quality improvement program.MethodsThe study population consisted of 2218 consecutive patients undergoing isolated coronary artery bypass grafting from 2007 to 2009 in a university-based quality improvement program that emphasizes involvement of all surgeons in the academic quality endeavor. The endpoints included operative mortality, major morbidity, and National Quality Forum-endorsed process measures as defined by the Society of Thoracic Surgeons. The procedural volume was analyzed as a categorical and continuous variable using general estimating equations, which accounted for clustering effects and which were adjusted for Society of Thoracic Surgeons risk scores and the propensity for operation in a low- versus high-volume program.ResultsThe annual program volume ranged from 67 to 292 (median, 136; interquartile range, 88–224) and surgeon volume from 1 to 124 (median, 58; interquartile range, 30–89). The mortality rate among the hospitals was 0.47% to 2.23% (0.8% overall), and the observed/expected mortality ranged from 0 to 1.20 (0.41 overall). When comparing low-volume (