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Post-traumatic epilepsy (PTE) is acquired epilepsy after traumatic brain injury (TBI). Despite the availability of more than 20 antiseizure medications (ASMs), there is no way at present to prevent epileptogenesis in TBI survivors, and many cases of PTE become drug-resistant. Importantly, the adverse effects of ASMs can significantly affect patients' quality of life. Mammalian models are commonly used for studying refractory PTE, but are expensive and laborious. Zebrafish models have become popular for studying epilepsy, but most focus on larvae, and there have been no reports to date of pharmacological screening in an adult zebrafish model of acquired epilepsy. Valid animal models are critical for understanding PTE and for developing novel therapeutics. The aim of the present study was to characterize the cognitive impairments of a zebrafish model of TBI that leads to the development of PTE. Using combined behavioral and electrophysiological approaches, we also characterized the pharmacological effects of the most commonly used ASMs to manage PTE (valproate, carbamazepine, and phenytoin). Zebrafish with PTE exhibited impairments in learning and memory, difficulty in decision making, and reduced social preference. Valproate and carbamazepine had a limited protective effect against behavioral seizures, and all three drugs failed to significantly reduce electrographical seizures. The negative impacts of TBI and ASMs in zebrafish parallel those observed in other animals, making the zebrafish model of PTE a promising high-throughput model of refractory and drug-resistant epilepsy.

Objective Posttraumatic epilepsy (PTE) is defined as recurrent and unprovoked seizures occurring >1 week after traumatic brain injury (TBI). Animal studies of PTE are lengthy and expensive. In this study, we developed a cost-effective PTE animal model using zebrafish to bridge the gap between in vitro studies and low-throughput animal studies. Methods We used two different sets of parameters (G1 and G2) to induce closed-head TBI in adult zebrafish using pulsed high-intensity focused ultrasound. Injured fish and naive controls were evaluated for behavioral deficits and spontaneous behavioral seizure activity up to 21 days postinjury (DPI). We also assessed behavioral seizure susceptibility to a subconvulsive dose of pentylenetetrazole (PTZ; 2.5 mmol·L-1 ) and recorded electrophysiological signals to confirm seizure activity up to 40 DPI. In addition, we investigated injury-related changes in the blood-brain barrier and expression levels of various proteins altered in rodent and human TBI. Results The G2 parameters resulted in a more severe TBI, with a mortality rate of 25%, as well as motor dysfunction and heightened anxiety persisting at 21 DPI. One hundred percent of the G2 group showed spontaneous myocloniclike behavior, and 80% demonstrated tonic-clonic-like behavioral seizures by 21 DPI. Such activities were not detected in the naive group. After the application of 2.5 mmol·L-1 PTZ, 100% of injured zebrafish had cloniclike seizures at 21 DPI, versus 30% of the naive group. We also demonstrated electrographic seizure activity at 40 DPI, which was not detected in the naive controls. Lastly, we observed acute blood-brain barrier dysfunction and increased levels of HMGB1 and ratios of phosphorylated/total Akt and tau through 21 DPI. Significance Together, the results indicate that severe TBI in the adult zebrafish leads to similar behavioral and physiological changes to those of more traditional models, including the development of PTE, and suggest this may be a useful model that can accelerate research in TBI/PTE.

Traumatic brain injury due to primary blast exposure is a major cause of ongoing neurological and psychological impairment in soldiers and civilians. Animal and human evidence suggests that low-level blast exposure is capable of inducing white matter injury and behavioural deficits. There are currently no effective therapies to treat the underlying suspected pathophysiology of low-level primary blast or concussion. Remote ischemic conditioning (RIC) has been shown to have cardiac, renal and neuro-protective effects in response to brief cycles of ischemia. Here we examined the effects of RIC in two models of blast injury. We used a model of low-level primary blast in rats to evaluate the effects of RIC neurofilament expression. We subsequently used a model of traumatic brain injury in adult zebrafish using pulsed high intensity focused ultrasound (pHIFU) to evaluate the effects of RIC on behavioural outcome and apoptosis in a post-traumatic setting. In blast exposed rats, RIC pretreatment modulated NF200 expression suggesting an innate biological buffering effect. In zebrafish, behavioural deficits and apoptosis due to pHIFU-induced brain injury were reduced following administration of serum derived from RIC rats. The results in the zebrafish model demonstrate the humoral effects of RIC independent of anesthetic effects that were observed in the rat model of injury. Our results indicate that RIC is effective in improving outcome following modeled brain trauma in pre- and post-injury paradigms. The results suggest a potential role for innate biological systems in the protection against pathophysiological processes associated with impairment following shockwave induced trauma.

Factors impacting the accuracy of ultrasound (US) diagnosis of cleft lip (CL) and its subsequent effect on parents are not well understood. Our objectives were to evaluate how the type of CL (complete versus incomplete) and associated cleft palate affect the accuracy of CL's prenatal diagnosis and to evaluate differences between parents' perception of prenatal US in cases of true-positive versus false-negative results. The authors performed a retrospective review of all patients who underwent repair for nonsyndromic CL following prenatal US. Patients were stratified by type of CL and associated cleft palate. Parents were called to determine if their child's CL was diagnosed via US and their perception of the results. Forty-seven children with complete and 40 with incomplete CL responded to phone calls. The presence of a complete CL (P = 0.001) and an associated cleft palate (P = 0.014) were independently associated with an increased likelihood of prenatal diagnosis. Parents who received a true-positive prenatal diagnosis of CL were more satisfied than those who received a false-negative diagnosis (P = 0.0063). True-positives perceived knowing of their child's diagnosis in advance to be more helpful than false-negatives believed it would have been. These results afford an improved context to interpret US studies and help physicians provide more informed prenatal counseling.

Vascular dysfunction arising from blood-brain barrier (BBB) breakdown after traumatic brain injury (TBI) can adversely affect neuronal health and behavioral outcome. Pericytes and endothelial cells of the neurovascular unit (NVU) function collectively to maintain strict regulation of the BBB through tight junctions. Secondary injury mechanisms, such as pro-angiogenic signals that contribute to pericyte loss, can prolong and exacerbate primary vascular injury. Human umbilical cord perivascular cells (HUCPVCs) are a source of mesenchymal stromal cells (MSCs) that have been shown to reduce vascular dysfunction after neurotrauma. We hypothesized that the perivascular properties of HUCPVCs can reduce vascular dysfunction after modeled TBI by preserving the pericyte-endothelial interactions. Rats were subjected to a moderate fluid percussion injury (FPI) and intravenously infused with 1,500,000 HUCPVCs post-injury. At acute time points (24 h and 48 h) quantitative polymerase chain reaction (qPCR) analysis demonstrated that the gene expression of angiopoietin-2 was increased with FPI and reduced with HUCPVCs. Immunofluorescent assessment of RECA-1 (endothelial cells) and platelet-derived growth factor receptors (PDGFR-β) (pericytes) revealed that capillary and pericyte densities as well as the co-localization of the two cells were decreased with FPI and preserved with HUCPVC administration. These acute HUCPVC-mediated protective effects were associated with less permeability to Evan's blue dye and increased expression of the tight junction occludin, suggesting less vascular leakage. Further, at 4 weeks post-injury, HUCPVC administration was associated with reduced anxiety and decreased β-amyloid precursor protein (β-APP) accumulation. In summary, HUCPVCs promoted pericyte-endothelial barrier function that was associated with improved long-term outcome.

Pollution prevention methods were applied at an optics manufacturer in an effort to improve recovery of a valuable polishing component, cerium oxide (ceria), 77% of which was lost to dragout and sewer discharge. Centrifugation and microfiltratiion were evaluated to develop a process that would increase recovery of used ceria, which would then be sent back to the ceria supplier for reclamation and reuse. Full-scale implementation included a high-speed centrifuge that operates continuously with a microfiltration system through recirculation in a single process tank. Sydor Optics has improved ceria recovery from 23% to 48%, saving thousands of dollars annually.

Solar energy has become a viable alternative energy because it is a clean type of energy that converts solar radiation into heat energy for various applications such as heating water, power generation, cooking, and food drying. The solar dryer, integrated with the heat energy storage system, uses nitrate salt as a heat storage medium which was designed and tested by drying 1000 grams of red pepper at 19.6 to 62.4°C. The average ambient temperature ranged from 19.3 to 37.4°C, and the maximum temperature of the heat storage media ranged from 87.8 to 125°C. The solar drying process was compared to open sun drying system loaded with 1000 grams of red pepper. The findings showed that the solar dryer maintained color and flavor and lowered the original moisture content from 86% to 10% for 24 hours compared to 36 hours of drying in open air. In this study, nitrate salt is shown to be the perfect heat storage medium for drying food products; it preserved heat for about 4 hours when there is no active sunlight.

The world today increasingly relies upon the usage of smart devices which have the capability to communicate with other systems and the cloud. Cyber-Physical Systems (CPS) are one such application of smart devices making use of network mediums for augmented communication capabilities. Problems and risks arise when the messages being sent via the network are not secure, as this would allow adversaries to manipulate and ultimately compromise the entire system. In the past, implementing security to these system have been more reactive than proactive. This paper illustrates the design of a CPS testbed in which different security implementation methods can be tested upon and analysed. The abstraction of the CPS testbed and an adversary model that shows where attacks may occur are then discussed.

Summary:. Surgical disease is now among the most common, preventable, and growing contributors to the global burden of disease. The attitudes of trainees toward global surgery and the viability of a global surgery as an academic track have blossomed. More optimized experiences within residency education are necessary, however, to prepare the next generation of global surgeons. The field of plastic surgery is thus at an important crossroads in the effort to incorporate global surgery into training programs in a uniform fashion across the country. The recent American Council of Academic Plastic Surgeons meeting in February 2020 was dedicated to identifying strategies that will enhance the adoption of global surgery practices within plastic surgery. In this article, we discuss the principles, themes, and ideas that emerged from this session, and further develop concrete initiatives believed to be potentially fruitful. Some have been discussed in other surgical disciplines or presented in isolation to the plastic surgery community, but never as a cohesive set of recommendations that take into account the background and shortfalls of the current model for global health education in the 21st century. We then introduce five recommendations to optimize learner education: (1) clarification of learner expectations and roles; (2) domestic teaching for optimization of field experiences; (3) expansion of longitudinal, formal rotations; (4) strengthening of the role of research; and (5) integration of program financing.

This article proposes a pair of projects offered in a single studio course that challenges design students to design and develop interactive data visualizations for the web through prototyp...

The present study uses power data from panel meter connected to the micro-grid to identify electrical energy consumption of the school appliances and their behavior in both warm-up, standby and active operation states. Before the conduction of experiments a load auditing of the school appliances was carried out by reading the rated power of each device (e.g. photocopy machine, printer, and fridge). The captures of this kind of information were essential as it provides a starting point to determine energy use of each appliance and hence simplify the process of identification. The electric parameters such as active power, reactive power and current were used to analyze the behavior of electrical appliances in all states. Experimental results show that, both active and reactive power were found to be high for old Canon photocopy machine as compared to new Canon photocopy machine. Another experiment reveals that printing one copy by using HP laser printer consumes about 700 W, while photocopying one copy with new Canon machine utilizes approximately 1100 W. This study concludes that new photocopy machine consumes more electric energy in warm-up state as compared to other states (standby and active operation states). Future work is to develop an algorithm for demand side management strategies which will enable efficient utilization of the electric energy from the micro-grid and hence bring the intended energy impact to the school.

Supplemental Digital Content is available in the text., Background: Although efforts to improve access to care for patients with cleft lip in the developing world have grown tremendously, there is a dearth of data regarding aesthetic outcomes after cleft lip repairs in this setting. Defining severity-outcome relationships has the potential to improve efficiency of care delivery in resource-limited settings, and to improve overall results. In this study, we investigate the relationship between initial cleft lip severity and early aesthetic outcomes following surgical repair of primary unilateral cleft lip. Methods: Using previously validated tools to assess unilateral cleft lip severity and aesthetic outcome after repair, we evaluated 1,823 consecutive patients who underwent primary unilateral cleft lip/nose (UCL/N) repair. Three separate evaluators scored each case for a total of 5,469 total independent evaluations. Results: Our results show that with increasing severity of UCL/N deformity, there is a corresponding decrease in early aesthetic outcome scores. Using our results, we established normative early aesthetic outcomes following repair for each severity grade of UCL/N deformity. Conclusions: In conclusion, this study has achieved a standardized, timely, and cost-effective evaluation of 1,823 surgical cases of primary UCL/N repair. This data set provides a normal distribution of aesthetic results according to initial cleft severity and defines a standard of “expected” aesthetic results after primary UCL/N repair. Our results also show a clear correlation between initial severity and immediate aesthetic result after surgery, though we also show that excellent results are possible regardless of initial cleft severity.

In developing countries, energy is recognized to be essential for promoting equitable growth, fostering social inclusion and preserving the environment. Nevertheless, the current state of the energy sectors of developing countries still represents a major hindrance to the fulfillment of this goal. In this frame, electrical energy storage may allow a cost-effective exploitation of renewable sources in order to cope with the improvement of the power supply service via local national grids, but mainly it may become a building block of rural electrification through integration within off-grid systems. This paper focuses on electrical energy storage in sub-Saharan Africa providing an overview of the main aspects of this theme. Indeed, the specific features of the power sector in sub-Saharan Africa are analyzed about the framework of application of electrical energy storage. The typical technologies implemented in this context and the status of the market as well as of the economic models to support the diffusion of storage together with renewable energy technologies are highlighted. Moreover, an overview of technical aspects such as storage capacity sizing and interface converters for integration with renewables are described. Finally, an experimental application of a hybrid micro-grid in rural Tanzania is presented. With this paper, our aim is to provide an overall view, within the main technical and non-technical aspects, of electrical energy storage in a context – sub-Saharan Africa – which has a huge potential, both in market terms, but also with regards to the possibility to develop and implement alternative technical solutions which may be integrated in the power systems of high income countries as well. © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ available 1 november 2018

The purpose of this collaborative qualitative study was to investigate the lived experience of women leaders in South Korean companies who manage their work and life and develop their leadership in the face of organizational and cultural constraints. Critical to this investigation was the understanding of three concepts represented in the literature on women in leadership: cultural context, work-life balance, and leadership development. A team of eight researchers conducted a collaborative qualitative study to interview 50 women leaders using a purposeful and snowball sampling method. As a result, we found that women leaders experience difficulties in work-life balance and leadership development largely due to a gendered workplace. By gendered workplace we mean frequent drinking after work, the exclusion of women leaders from informal networking, and a lack of developmental opportunities. The gendered workplace forced them to sacrifice their personal lives in order to work long hours and develop their own strategies for work-life balance. We also found that there were noticeable differences in their narratives by position (28 team leaders and 22 executives) and marital status (37 married and 13 singles) concerning family support, major challenges, definitions of success, leadership styles, and mentors. Based on the study findings, we provided implications for research and practice and the study limitations.

Although there is a high incidence of flank defects after lateral abdominal access, there is a paucity of large studies discussing this problem. Most studies express nihilism regarding their surgical management. The goal of this study was to describe the authors' conceptualization of flank defects, with a determination of the number of true hernias versus bulges, and outcomes of surgical repair in these patients.The authors carried out a 13-year retrospective review of 31 consecutive flank defects repaired by the senior author (G.A.D.). Patients were treated with a 7.5-cm-wide macroporous polypropylene mesh and reapproximation of the abdominal wall to achieve a direct supported repair. There were 19 intraperitoneal placements and 12 placements between the external and internal oblique muscles or preperitoneal space. The prevalence of true hernia versus bulge at the time of repair was noted.There were no surgical-site infections. Two patients developed minor bulges at the prior hernia site: one of these was repaired with additional mesh, and the other one was observed. One small asymptomatic recurrent hernia was noted incidentally on a follow-up computed tomographic scan. Initially, 10 patients had a complete hernia through all layers of the lateral abdominal musculature, 17 patients had dehiscence of the internal oblique and transversus abdominis muscles with an intact external oblique muscle, and four patients had denervation with all layers of the abdominal wall intact.Most flank defects represent true hernias rather than denervation injuries. Direct supported repair of flank hernias using mesh is a safe and effective technique.Therapeutic, IV.

Study design Retrospective clinical study. Purpose To assess the diagnostic value of suction drain tip culture in patients undergoing primary posterior spine surgery. Overview of literature To date, the diagnostic value of suction drain tip culture for predicting surgical site infection (SSI) has not been firmly established in orthopedic or spinal surgery. Methods In total, 133 patients who underwent primary posterior spine surgery from January 2013 to April 2015 were included in this retrospective study. Patients diagnosed with infective disease or condition was excluded. The suction drain tip was cut off approximately 5 cm from its far end. The sample was sent to the microbiological laboratory of the hospital for culture analysis. Any signs of infection, such as wound discharge or dehiscence, fever, chills, or chronic pain, were recorded. The culture outcome, identification of bacteria, and postoperative transition of the serum C-reactive protein level were also recorded in all patients. The wounds were followed up for a minimum of 3 months. Results A positive drain tip culture was found in 48 patients (36.1%), of whom, 6 developed SSI. The sensitivity of drain tip culture for SSI after primary posterior spine surgery was 60.0%, and the specificity was 65.9%. The association between the incidence of positive suction tip culture and SSI was not statistically significant. Among the 48 positive drain tip cultures, there was no significant association between the occurrence of SSI and virulence of isolated bacteria. There was no significant association between drain tip culture positivity and the duration of drainage, or between the rate of SSI and duration of drainage. Conclusions Suction drain tip culture analysis is a poor predictor of SSI after primary posterior spine surgery. Routine use of a drain tip culture is not supported by the results of this study.

Novel targeted therapies have substantially improved the prognosis of patients with B cell malignancies. However, a substantial fraction of patients still relapse, even after initially achieving deep remissions. Many studies have characterized the interactions between tumor cells and their microenvironment as integral to leukemia/ lymphoma homeostasis and for the provision of survival signals, also contributing to drug resistance (referred to as environment-mediated drug resistance (EMDR)). Therapeutic efforts to antagonize microenvironment-emanating survival cues have predominantly focused on perturbation of tumour cell adhesion enabling the physical displacement from protective niches (e.g. BCR-inhibitors). In an effort to address whether direct stromal targeting could more precisely mitigate EMDR, we recently characterised the molecular mechanisms underlying tumor-stroma interactions in B cell malignancies and identified a protein kinase C-β (PKC-β) as an essential kinase, required for activation of NF-κB in mesenchymal stromal cells (Lutzny et al Cancer Cell 2013). The dependency on stroma PKC-β was uniformly found for acute (ALL) and chronic (CLL, MCL) B cell malignancies. Importantly, our data further demonstrate that targeting stroma PKC-β is of key importance for multi-drug resistance of malignant B cells and can be used for therapeutic interventions (Park et al Science Trans Med 2020). Here we demonstrate novel mechanistic insights into stroma-mediated drug resistance in B cell malignancies. We identified that stroma PKC-β drives a transcriptional program in tumor cells, dependent on the activation of TGF-β and BMP-signaling, which ultimately leads to the stabilisation of BCL-XL. Our data show that BCL-XL expression in tumor cells is associated with SMAD1-induction by cytotoxic therapies, which simultaneously suppress SMAD4 expression. Importantly, SMAD1 expression was strictly dependent on stromal PKC-β activity. Antagonizing stroma signals with TGF-β inhibitors inhibits SMAD1 induction, abrogates the up-regulation of BCL-XL and overcomes stroma-dependent resistance to Venetoclax and conventional chemotherapy. The TGF-β pathway operates in parallel to the activation of the transcription factor EB (TFEB) as a down-stream target of PKC-β. Interference with these signaling pathways impairs plasma membrane integrity of stromal cells by down-regulation of numerous adhesion and signaling molecules, such as ADAM17, required for the reciprocal stabilization of BCL-XL in tumor cells. The significance of microenvironment PKC-β for drug resistance was demonstrated in vivo, using C57B/6 mice, diseased with EμTCL-1 driven B cell tumors and treated with Venetoclax in combination with or without PKC-β inhibitors. Combined treatment significantly prolonged survival, based on PKC-β mediated impairment of EMDR. Similarly, concurrent treatment of PKC-β inhibitors with chemotherapy also improved survival in an ALL-PDx model Our data demonstrate that mitigating EMDR with small molecule inhibitors of PKC-β or TGF-β signalling enhance the effectiveness of both targeted and non-targeted chemotherapies and moreover, has the ability to overcome Venetoclax resistance in B cell malignancies. Clinical trials with repurposed drugs inhibiting the here described pathways mediating EMDR are in planning. Disclosures No relevant conflicts of interest to declare. OffLabel Disclosure: Midostaurin as inhibitor of stroma PKC-β

Novel targeted therapies have substantially improved the prognosis of patients with B-cell malignancies. However, a substantial fraction of patients relapse, even after initially achieving deep remissions. Many studies have characterized the interactions between tumor cells and their microenvironment as integral to leukemia/lymphoma homeostasis and for the provision of survival signals, also contributing to drug resistance (referred to as environment-mediated drug resistance [EMDR]). Therapeutic efforts to antagonize microenvironment-emanating survival cues have predominantly focused on perturbation of tumor cell adhesion enabling the physical displacement from protective niches. In an effort to address whether direct stromal targeting could more precisely mitigate EMDR, we antagonized stromal expressed PKC-beta, which we have previously shown to be a stroma-autonomous signaling pathway critical for the survival of malignant B cells (Lutzny et al., Cancer Cell 2013). The dependency on stroma PKC-b was uniformly found for acute (ALL) and chronic (CLL, MCL) B-cell malignancies. In particular, our data demonstrate that stroma PKC-b is of key importance for multidrug resistance of malignant B cells (Park et al., Science Trans Med 2020). Here we demonstrate novel mechanistic insights into stroma-mediated drug resistance in B-cell malignancies. We identified that stroma PKC-b drives a transcriptional program, activating TGF-b and BMP-signaling in tumor cells. Our data show that antagonizing stroma signals with TGF-b inhibitors abrogated upregulation of BCL-XL and overcomes stroma-dependent resistance to venetoclax. This activation operates in parallel to the activation of the transcription factor EB (TFEB) as a downstream target of PKC-b. Interference with these signaling pathways impairs plasma membrane integrity of MSCs by downregulation of numerous adhesion and signaling molecules (e.g., ADAM17), required for the reciprocal stabilization of BCL-XL in tumor cells. The significance of microenvironment PKC-b for drug resistance was demonstrated in vivo, using C57B/6 mice, diseased with EuTCL-1 driven B-cell tumors and treated with venetoclax in combination with or without enzastaurin (PKC-b inhibitor). Combined treatment significantly prolonged survival, based on PKC-b mediated impairment of lysosome biogenesis in vivo. Similarly, concurrent treatment of PKC-b inhibitors with chemotherapy also improved survival in an ALL-PDx model. Our data demonstrate that mitigating EMDR with small-molecule inhibitors of PKC-b or TGF-b signaling enhances the effectiveness of both targeted and nontargeted chemotherapies and, moreover, has the ability to overcome venetoclax resistance in B-cell malignancies in vivo. A clinical trial to test the dual inhibition of stroma and tumor cells in lymphoma patients is in preparation. Citation Format: Eugene Park, Jingyu Chen, Andrew Moore, Maurizio Mangolini, Joseph R. Byod, Hilde Schjerven, James C. Williamson, Paul J. Lehner, Michael Leitges, Alexander Egle, Marc Schmidt-Supprian, Seth Frietze, Ingo Ringshausen. Overcoming venetoclax resistance in B-cell malignancies by antagonism of stromal TGF-beta-mediated drug resistance [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr PO-62.

Accurate clinical diagnosis of mild traumatic brain injury (mTBI) is limited by assumptions of underlying pathophysiology based on external examination, self-reporting, and limited imaging capabilities. Translational research bridges pathophysiology from animal models to address clinical uncertainty. These studies have been crucial to understanding underlying mechanistic events in greater detail and in identifying putative therapeutic targets and strategies. However, the clinical unknowns and attempts to understand them through translational research inevitably lead to disconnects between translational models and clinical reality. Contributing factors include the validity of animal models of mTBI and what information can be reliably extrapolated to human pathophysiology. Accurate diagnosis for an injury that can manifest as subclinical not only presents a significant hurdle in determining the epidemiological magnitude of mTBI but also presents technical difficulties in translational model building. This chapter highlights efforts in translational and clinical research to address the complex and heterogeneous challenges of mTBI.

The variable topology truss (VTT) system is a new type of modular platform that enables control over both the shape and topology of a truss, bringing both the efficiency of variable geometry trusses and the flexibility of self-reconfigurable robots. A VTT has the capability to enter a disaster site and shore damaged structures to assist with rescue work. This paper presents a revised overview of the VTT hardware design, enhanced from our previous works. We propose an active VTT spherical joint, which can address the hardware-related issues and also simplify the VTT software. Additionally, reconfiguration and locomotion planning algorithms for VTT are presented. We propose a retraction-based RRT method especially suitable for VTT and show our algorithm is superior to basic RRT in a practical 21-member VTT scenario. The locomotion algorithm implements a rolling gait under kinematic constraints; simulation results for a 21-member VTT show our algorithm yields accurate trajectory tracking.

In order to achieve the objective of universal electricity access by 2030, new microgrids need to serve 630 million people globally. To achieve this goal, new finance models need to be developed and implemented. Load profiles of rural consumers are crucial for off-grid systems capacity planning and control. The combination of detailed load profiles with benefit assessment of rural electricity can provide important insights into the social dynamics of communities ready to adopt microgrid technologies and an important incentive to guide demand side management. We propose a Load Profile - Benefit Assessment (LPBA) methodology that integrates microgrid data, analyzed through mean shift clustering clustering technique, with mixed method instrumentation to adequately assess the impact electricity use has on consumers. Enabled by wellbeing assessment methodology, LPBA could change the perceived investment risk by taking a deeper look at the reasons why a rural electrification business succeeds or fails. Preliminary data from a case study of a rural secondary school in Tanzania is used here to illustrate the methodology. While microgrids connected to a reliable grid seek to reduce cost or maximize the hours of power output when the price per kWh is higher, the LPBA provides a general guideline for microgrid users to manage power consumption with the goal of maximizing wellbeing benefits. Initial results indicate that in order to scale up methodologies such as LPBA, innovation is needed in affordable smart meters, near-real time signal processing tools, and transactive energy appropriate technology.

Objective: To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region. Patients and Design: We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center. Setting: Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India. Main Outcome Measure: Overall complication rates following cleft lip and cleft palate repair. Results: Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons ( P < .05). Conclusions: Our findings support the notion that transitioning from a mission-based model to a permanent facility-based model of cleft care delivery in the developing world can lead to decreased complication rates.

Summary:. Neuromas can be a debilitating cause of pain and often negatively affect patients’ quality of life. One effective method of treatment involves surgical resection of the painful neuroma and use of a processed nerve allograft to repair the injured nerve segment. Giving the nerve “somewhere to go and something to do” has been shown to effectively alleviate pain in upper and lower extremities. We present the first report of this concept to treat a painful neuroma of the abdominal wall that developed following a laparoscopic gastric bypass. The neuroma was excised, and the affected nerve was reconstructed using a processed nerve allograft as an interposition graft, with resolution of pain and gradual return of normal sensation. Patient-reported outcomes were measured using the Patient Reported Outcomes Measurement Information System. Neuroma excision with concurrent interposition grafting using processed nerve allografts may be a promising method of treatment for postsurgical painful neuromas of the trunk.

Chronic subdural hematoma (CSDH) is a common neurological occurrence in the elderly population with significant impact on the quality of life and work. Studies have attempted to determine the risk factors and pathophysiological mechanisms of CSDH using models in numerous mammalian species. To date, these animal models have only been able to reproduce limited durations of hematoma which does not accurately reflect the chronic state of CSDH. To address some of these challenges we modified a rat model of CSDH using two consecutive injections of autologous blood resulting in a hematoma of more than three weeks. We observed inflammatory and angiogenic changes related to the development and recovery of CSDH. In this study the technique for producing a CSDH in a small animal model had a success rate of 78.13%. The hematoma was sustainable up to 24 days. Hematoma resolution was associated with a gradual decrease in local pro-inflammatory factors and gradual increase in anti-inflammatory factors as well as proliferation and subsequent maturation of newly formed vessels. These events were also associated with improved behavioral outcome. Expression of anti-inflammatory cytokines also paralleled reabsorption of the hematoma. Reduction in hematoma size was also associated with neurological recovery. These data suggest that vessel maturation and anti-inflammatory pathways may contribute to the resolution of CSDH and neurological recovery. The regulation of the two mechanisms is a potential target for the treatment of CSDH. The modified model of rat CSDH demonstrated a high level of reproducibility in our hands and may be useful in future CSDH studies.

Segmented-in-series solid oxide fuel cell (SIS–SOFC) is prepared by laminating cell components on all sides of partially stabilized zirconia supports using decalcomania method. Since such support is conductive, it generates shunting current and hence voltage loss occurs. Such loss compromises the benefit achieved by segmenting solid oxide fuel cell in series. Therefore there would be greater merits to study the effect of cell-to-cell distance on the voltage loss. Output characteristics according to the cell distance is reported in this study. Open circuit voltage and maximum output density show higher value in the order of cell distance of 2, 3 and 1 mm. While the shunting current decreases with increasing cell distance, the ohmic resistance, however, increases with increasing cell distance as the interconnector length increases. The impedance analysis shows that the polarization resistance decreases substantially as the cell distance decreases. This study demonstrates that care should be taken for the SIS–SOFC as the cell-to-cell distance influences the output characteristics.

Background Lower eyelid retraction is a difficult problem to treat, but it is a prevalent condition and a common complication of blepharoplasty. The use of spacer grafts to increase eyelid height and improve symptoms has been described for a long time, but the optimal choice of spacer graft material is unknown. Objectives The authors reviewed the currently available evidence to determine the best available spacer graft material in terms of efficacy and complications. Methods A systematic review of all available literature published between 1985 and the present was performed using the Pubmed, Ovid MEDLINE, and Cochrane library databases. Inclusion criteria were that the studies contain original content assessing the treatment of lower eyelid retraction in humans using a spacer graft and provide quantitative outcomes data. Results One hundred and twelve articles were reviewed following an initial screen using titles, and 19 articles were chosen for inclusion in this systematic review. Analysis of these articles revealed no spacer graft material that is clearly superior to others. Conclusions Due to a lack of high quality evidence, this review did not reveal one spacer graft material that is clearly superior to others. However, a narrative summary of the available evidence reveals unique sets of advantages and disadvantages associated with the various materials currently available. Further research in the form of well-designed studies will be necessary to further clarify advantages of certain spacer graft materials over others. Level of evidence 5.

Death after withdrawal of mechanical ventilation frequently follows the sequence of progressive hypoxemia and hypotension leading to cardiac arrest. Accurate timing of the determination of death is fundamental to trust in controlled donation after circulatory death (cDCD) programs and is generally based on cessation of circulation (pulselessness), brain function (apnea), and the passage of time. If death is understood to be the unresuscitatable loss of brain function, the clinical determination that death following apnea and pulselessness has occurred is largely inferential. We sought to elucidate the relationship between the available clinical variables and the loss of brain function and its inability to be resuscitated. We developed a rat model of progressive hypoxia resulting in apnea and circulatory failure. We monitored clinical physiological variables including heart rate, respiration, and arterial pulse pressure. In addition, we simultaneously monitored spontaneous and evoked brain activity within the hippocampus through microelectrode field potential recordings. We also examined neurological function following restoration of pulmonary and circulatory function. Our data provide evidence that in a model of progressive hypoxemia, loss of spontaneous and evoked brain activity preceded the loss of circulation. Importantly, the data suggest that the loss of brain function, in the presence of restored cardiopulmonary indices, occurred at a time point after apnea but before the loss of detectable arterial pulse pressure. These are important data that act as a conceptual reference point when clinicians undertake the inferential activity of identifying the time prior to which a patient has died following progressive hypoxemia and while observing apnea and pulselessness.

BACKGROUND: Biologic mesh is commonly used in abdominal wall reconstruction but may result in increased hernia recurrence. There are minimal data on repair of these recurrent hernias. METHODS: We conducted a retrospective chart review of 24 patients presenting to a single surgeon with recurrent ventral hernia, previously repaired with biologic mesh. RESULTS: Seventeen of 24 study patients underwent open repair, including 5 revisions of incomplete external oblique release. Mesh was polypropylene in 11 patients and fenestrated condensed polytetrafluoroethylene in 3 patients. In 1 patient, no mesh was used. In 2 patients, bridged biologic mesh was used because of risk of exposure. All biologic repairs have since recurred. Complications occurred in 3 of 15 prosthetic mesh patients and in all biologic mesh patients. CONCLUSIONS: Prior components release can be repeated if computed tomography scan reveals incomplete release. Recurrence is common after bridged biologic mesh repair. Conventional mesh can be used safely in many recurrent abdominal hernias after biologic mesh failure.

After studying this article, the participant should be able to: (1) Thoroughly recognize the factors that contribute to hematoma after face lift. (2) Describe and apply the current evidence for which technique gives superior results in outcomes after face lift. (3) Use the current evidence to determine whether to incorporate fibrin sealant into the practitioner's intraoperative routine, and its effects on bleeding, fluid accumulation, and bruising. (4) Explain an approach for controlling blood pressure in the perioperative period after face lift. (5) Describe the benefits of controlling nausea and vomiting after face lift. (6) Use appropriate measures to reduce the risk of venous thromboembolism when performing face lift. (7) Assess the role of different forms of local anesthetic in reducing postoperative hematoma.This article provides a review of the latest evidence regarding the preoperative assessment and perioperative management of patients undergoing face lift. The effects of various pharmacologic interventions and surgical techniques on postoperative complications are also reviewed. In addition, a meta-analysis of recent literature was performed to compare the rates of postoperative hematoma formation following various face lift techniques.

This study reflects two photovoltaic (PV) power generations, at Karume Institute of Science and Technology (KIST) - Zanzibar and The Nelson Mandela African Institution of Science and Technology (NM-AIST) - Arusha in Tanzania. The output data sets from each site were verified for possible PV simulation of different operational scenarios to obtain the optimum design configuration. The HOMER software was used to analyze the entire operation of the system. The effect of the accuracy of the photovoltaic integration was determined by analysis of different operational behaviors of the simulated PV levels. Furthermore, the overall performance of the station per site was analyzed for technical, economic and environmental constraints as well as their comparative cost-benefit analysis. The study finds that there is a high sensitivity in the demand for the load (i.e. load growth) whose system performance is characterized with minimum: total net present cost (NPC) of $474,745 and $29,169, feed in tariffs, levelized cost of energy (LCOE) of $1.06/kWh and $0.0118/kWh, total energy output and renewable fraction of 15% and 22% for KIST and NM-AIST respectively, thus support the use of photovoltaic power sources in the generation of energy than their counterpart alternatives because of the best technical performance and is less dependent on other external sources of energy, and simultaneously has good economic and environmental performance

Background/Aims: Surgical resection or ablation is recommended for the treatment of early hepatocellular carcinoma (HCC), whereas transarterial chemoembolization (TACE) is frequently used in early HCC ineligible for curative resection. We evaluated the clinical effects and safety of radiofrequency ablation (RFA) shortly after TACE in patients with Barcelona clinic liver cancer (BCLC) stage A HCC. Methods: Sixty-seven BCLC stage A HCC patients who failed to achieve complete response to TACE as either a first line treatment and who subsequently received RFA at the Konkuk University Medical Center from January 2005 to December 2017 were included. Evaluation indices included treatment response, overall survival rate, recurrence-free survival, prognostic factors, and procedure-related complications. Results: Median follow-up was 46.9 months. Fifty-four (80.6%) patients were of Child-Pugh class A, and 13 (19.4%) were of class B. Modified UICC stages were I in 10 (14.9%), II in 46 (68.7%), and III in 11 (16.4%) patients. In the 67 study subjects, cumulative recurrence-free survival rates were 86.8%, 55.9% and 29.7% at 1, 3, and 5 years, respectively, and overall survival rates were 100%, 93.4%, and 83.5% at 1, 3, and 5 years, respectively. Tumor size significantly predicted recurrence. No treatment-related death occurred. Conclusions: Combination of RFA was an efficient and safe treatment for BCLC stage A HCC patients that failed to achieve complete response to initial TACE. We suggest TACE plus RFA be considered as a curative option for early HCC patients ineligible for curative resection of RFA. (Korean J Gastroenterol 2019;73:167-176)

Purpose To determine the amount of shortening needed in an ulna to achieve final neutral ulnar variance in adolescents with ulnar impaction syndrome. Radiological and clinical outcomes were evaluated after ulnar shortening and after growth had stopped. Methods From February 2006 to February 2009, we prospectively followed 16 consecutive patients treated with a shortening osteotomy for positive ulnar variance. The study group included 10 boys and 6 girls with an average age of 16.1 years. The closed medial half-side of the physis of the distal radius was used to measure the variance as a reference for the ulna. Based on the radius without any growth potential, the amount of shortening was determined for the ulna with potential for further growth. The preoperative, postoperative, and final ulnar variances were evaluated. The clinical results were compared before surgery and at the time of growth termination. Results Preoperative ulnar variance was 3.4 mm ± 0.6 mm and the amount to be shortened was 6.1 mm ± 1 mm. The final ulnar variance was 0.2 mm ± 0.3 mm. The mean visual analog scale pain score improved from 6.6 ± 1.0 before surgery to 2.2 ± 0.5 after surgery. The mean range of forearm rotation increased from 132° ± 11° before surgery to 170° ± 16° at final follow-up. In addition, grip strength was 15.3 kg ± 7.6 kg (71% of grip strength on the unaffected side) before surgery and 19.8 kg ± 4.9 kg (90% of grip strength on the unaffected side) at final follow-up. The modified Mayo Wrist Score was 85 ± 8 at the final follow-up. No cases of complications or treatment failure occurred. Conclusions Ulnar shortening was considered a useful procedure for adolescents with ulnar impaction syndrome, particularly if the measurement for the shortening amount was determined using the physis of the distal radius and ulna. Type of study/level of evidence Therapeutic IV.

Purpose To prospectively compare the clinical and radiological outcomes of 2 treatment methods for unstable distal ulna fractures associated with distal radius fractures in patients 65 years of age and older. Methods From February 2008 to March 2010, the first 29 ulnas were treated surgically (group 1) and the next 32 ulnas were treated nonoperatively (group 2). The mean final follow-up period was 34 months (range, 24–56 mo). All radiuses were fixed internally, in both groups. Clinical outcomes were compared between groups using a visual analog scale for postoperative pain; Disabilities of the Arm, Shoulder, and Hand scores; active range of motion; grip strength; and the modified system of Gartland and Werley. Radiological outcomes, including ulnar variance, were evaluated. Arthrosis was evaluated at the radiocarpal joint or distal radioulnar joint (DRUJ) according to the system of Knirk and Jupiter. Results There were no significant differences between the groups in any of the clinical outcomes. No significant differences were observed for radiological outcomes including ulnar variance, distal radius, and union rate. There were no patients in either group with symptomatic arthritic changes in the radiocarpal joint or DRUJ at the final follow-up. In group 2, 1 patient had malunion (angulated, 14°) on the anteroposterior view without evidence of arthrosis in the DRUJ, and functional outcomes were good. Conclusions In this population distal ulna fractures can be successfully managed nonoperatively when they occur in combination with distal radius fractures. Type of study/level of evidence Therapeutic II.

The use of polyethylene glycol (PEG)-based solutions is the gold standard for bowel preparation. However, PEG use might be associated with the risk of acute kidney injury.We aimed to compare the safety of 2 L PEG plus ascorbic acid (AA) versus 4 L PEG.Health examinees that underwent colonoscopy and blood tests on the same day at our center were included in this retrospective study. All subjects were prescribed either 2 L PEG plus AA or 4 L PEG for the bowel preparation prior to the colonoscopy. The incidences of electrolyte imbalance and renal impairment after colonic preparation were investigated. Renal impairment was determined if the subject's estimated glomerular filtration rate was measured less than 60 mL/min/1.73 mOf the 29,789 cases, 14,790 received 2 L PEG plus AA (group A) and 14,999 received 4 L PEG (group B) for colonic preparation. Renal impairment occurred more commonly in group A (n = 467, 3.2 %) than in group B (n = 189, 1.3 %). Electrolyte changes such as hypernatremia and hyperkalemia were more common in group A than group B, whereas hyponatremia, hypokalemia, and hypophosphatemia were more common in group B than group A. Old age, male sex, and the use of 2 L PEG plus AA were independent risk factors for renal impairment.The evidence strongly suggests that acute kidney injury is more likely to occur when 2 L PEG plus AA is used for the bowel preparation than when 4 L PEG is used.KCT0001703.

The Patient-Reported Outcomes Measurement Information System was used to evaluate the effects of open incisional ventral hernia repair on hernia-related pain.All patients who underwent elective repair of a primary or recurrent midline incisional hernia over a 3-year period completed Patient-Reported Outcomes Measurement Information System pain surveys and rated their pain intensity on a visual analogue scale. A retrospective review of these patients was performed.Seventy-seven patients underwent midline incisional ventral hernia repair and completed preoperative and postoperative surveys. Thirty-eight patients completed surveys at least 6 months after surgery. These patients demonstrated significant improvement in pain interference postoperatively (P.05) but not in pain behavior. Patients with higher pain intensity scores preoperatively had greater improvements in pain behavior and pain interference postoperatively.Patients with incisional ventral hernias have improvement in pain interference 6 months after open surgical repair. Changes are most pronounced in patients who experience higher magnitudes of pain preoperatively.

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We conducted a retrospective study to find out the optimum values of serum ferritin and other hematologic indices in adult anemic patients who should be referred for thorough gastrointestinal (GI) endoscopic evaluation for GI neoplasms. 544 adult anemic patients were stratified into three groups according to the results of GI endoscopy: benign versus premalignant versus malignant. As compared to non-malignant groups, malignant group demonstrated statistically significant differences in terms of median values of ferritin and total iron-binding capacity (TIBC) saturation. By receiver operating characteristics curve analyses to find out optimum cut-off points of the serum ferritin and TIBC saturation which distinguish between non-malignant diseases and malignant diseases, the cut-off ferritin value of 44.33 ng/mL in male had 72.73 % sensitivity and 70.95 % specificity. The cut-off TIBC saturation value of 9.13 % in male had 73.33 % sensitivity and 70.92 % specificity. The cut-off TIBC saturation value of 6.16 % in female had 69.57 % sensitivity and 65.13 % specificity. It is recommended that adult male patients with anemia undergo thorough endoscopic evaluation to detect GI neoplasms when their serum ferritin levels are ≤44 ng/mL or TIBC saturation values are ≤9 %. For adult female, only TIBC saturation values less than 6 % may contribute to determining whether they undergo GI endoscopic evaluation.

One of the more challenging portions of robot-assisted radical prostatectomy (RARP) is the urethrovesical anastomosis. Because of this, a unidirectional absorbable barbed suture (V-Loc(™)) has been used to complete the anastomosis with better efficiency and less tension. The effect of robotic needle driver manipulation on barbed suture is unknown. Therefore, the aim of this study is to determine whether robotic manipulation decreases the tensile strength and peak sliding force of V-Loc barbed suture.Fifty-six V-Loc sutures were compared with 56 Maxon sutures. All sutures were 3-0 caliber. Half of the sutures in each group were manipulated with a da Vinci(®) robot large needle driver five times over a 5 cm length of suture. The other half was not manipulated. Breaking force was determined by placing sutures in a Bose ElectroForce load testing device. For sliding force testing, 28 V-Loc sutures were manipulated in the same fashion and compared with 28 nonmanipulated V-Loc sutures. Peak force needed to make the suture slip backward in porcine small intestine was determined to be the sliding force. Scanning electron microscopy of the barbs before and after robotic manipulation was also performed.The mean difference in breaking forces for manipulated vs nonmanipulated Maxon sutures was 4.52 N (P=0.004). The mean difference in breaking forces for manipulated vs nonmanipulated V-Loc sutures was 1.30 N (P=0.046). The manipulated V-Loc group demonstrated a lower peak sliding force compared with the nonmanipulated group (0.76 vs 0.88 N, P=0.199). Electron microscopy revealed minor structural damage to the barbs and suture.Tensile strength and peak sliding force of V-Loc suture is decreased by robotic manipulation. This is likely because of structural damage to the suture and barbs. This structural damage, however, is likely not clinically significant.

Drinking water supplies are at risk of contamination from a variety of physical, chemical, and biological sources. Ranked among these threats are hazardous material releases from leaking or improperly managed underground storage tanks located at municipal, commercial, and industrial facilities. To reduce human health and environmental risks associated with the subsurface storage of hazardous materials, government agencies have taken a variety of legislative and regulatory actions—which date back more than 25 years and include the establishment of rigorous equipment/technology/operational requirements and facility-by-facility inspection and enforcement programs. Given a history of more than 470,000 underground storage tank releases nationwide, the U.S. Environmental Protection Agency continues to report that 7,300 new leaks were found in federal fiscal year 2008, while nearly 103,000 old leaks remain to be cleaned up. In this article, we report on an alternate evidence-based intervention approach for reducing potential releases from the storage of petroleum products (gasoline, diesel, kerosene, heating/fuel oil, and waste oil) in underground tanks at commercial facilities located in Rhode Island. The objective of this study was to evaluate whether a new regulatory model can be used as a cost-effective alternative to traditional facility-by-facility inspection and enforcement programs for underground storage tanks. We conclude that the alternative model, using an emphasis on technical assistance tools, can produce measurable improvements in compliance performance, is a cost-effective adjunct to traditional facility-by-facility inspection and enforcement programs, and has the potential to allow regulatory agencies to decrease their frequency of inspections among low risk facilities without sacrificing compliance performance or increasing public health risks.

Background There is scant literature regarding patient-reported outcomes after reconstruction for congenital hand syndactyly. Understanding patient perceptions of the postoperative outcome may facilitate a more evidence-based discussion of expectations after reconstruction. Methods All patients undergoing congenital syndactyly reconstruction at Ann and Robert H. Lurie Children's Hospital of Chicago between January of 2007 and December of 2015 were identified. Patient-Reported Outcomes Measurement Information System questionnaires were completed by patients; parent-proxy questionnaires were completed for patients 10 years of age and younger and those unable to complete the questionnaire independently. A retrospective chart review was also performed to capture demographic and clinical information. Results The authors identified 124 patients meeting inclusion criteria; 51 completed the Patient-Reported Outcomes Measurement Information System surveys (response rate, 41.1 percent). The survey score for upper extremity function was 41.8 ± 11. Upper extremity function was further impaired in patients with a documented history of developmental delay (23.8 ± 6.2 versus 44.2 ± 10.2). Parents completing surveys on behalf of their children reported higher pain interference scores than self-responders. Conclusions The Patient-Reported Outcomes Measurement Information System is a valuable tool for measuring patient-reported outcomes in patients with syndactyly. Patients who have undergone reconstruction for syndactyly experience minor impairments in upper extremity function, but other aspects of their health-related quality of life are comparable to those of the general population. Developmental delay may be associated with additional impairments in upper extremity function and should be discussed when considering surgical reconstruction.