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Blue-Green Infrastructure (BGI) and Sustainable Drainage Systems (SuDS) are increasingly recognised as vital components of urban flood risk management. However, uncertainty regarding their hydrologic performance and lack of confidence concerning their public acceptability create concerns and challenges that limit their widespread adoption. This paper investigates barriers to implementation of BGI in Portland, Oregon, using the Relevant Dominant Uncertainty (RDU) approach. Two types of RDU are identified: scientific RDUs related to physical processes that affect infrastructure performance and service provision, and socio-political RDUs that reflect a lack of confidence in socio-political structures and public preferences for BGI. We find that socio-political RDUs currently exert the strongest negative influences on BGI decision making in Portland. We conclude that identification and management of both biophysical and socio-political uncertainties are essential to broadening the implementation of BGI and sustainable urban flood risk management solutions that are practical, scientifically sound, and supported by local stakeholders. [ABSTRACT FROM AUTHOR]

In this study experimental data on a model soil in a cubical cell are compared with both discrete element (DEM) simulations and continuum analyses. The experiments and simulations used point source transmitters and receivers to evaluate the shear and compression wave velocities of the samples, from which some of the elastic moduli can be deduced. Complex responses to perturbations generated by the bender/extender piezoceramic elements in the experiments were compared to those found by the controlled movement of the particles in the DEM simulations. The generally satisfactory agreement between experimental observations and DEM simulations can be seen as a validation and support the use of DEM to investigate the influence of grain interaction on wave propagation. Frequency domain analyses that considered filtering of the higher frequency components of the inserted signal, the ratio of the input and received signals in the frequency domain and sample resonance provided useful insight into the system response. Frequency domain analysis and analytical continuum solutions for cube vibration show that the testing configuration excited some, but not all, of the system's resonant frequencies. The particle scale data available from DEM enabled analysis of the energy dissipation during propagation of the wave. Frequency domain analysis at the particle scale revealed that the higher frequency content reduces with increasing distance from the point of excitation. [ABSTRACT FROM AUTHOR]

Background: A strict gluten free diet (GFD) is the recognised treatment for patients diagnosed with coeliac disease (CD). As food prohibited to patients with CD has a high proportion of [...]

Objective: This study aimed to assess dynamic stability in individuals with end-stage ankle arthritis compared to healthy controls by evaluating the margin of stability (MoS) during gait., Design: A cohort of 50 participants with end-stage ankle arthritis (AA) and 50 matched healthy controls (HC) were analyzed from an IRB approved database. Kinematic data were collected using an eight-camera motion analysis system, and MoS was calculated based on the extrapolated center of mass (XCoM) and the base of support (BoS). Statistical analysis was performed using a linear mixed effects model with gait speed as a covariate., Results: The analysis revealed a significant interaction between the group (AA vs. HC) and limb (arthritic vs. non-arthritic) at heel-strike and midstance. The non-arthritic limb demonstrated a significantly smaller AP MoS during heel-strike compared to the arthritic limb and either of the limbs of the HC group (p < 0.001). The arthritic limb demonstrated a significantly greater ML MoS during midstance compared to the non-arthritic limb and either of the limbs of the HC group (p < 0.001). AA group had significant slower gait speed (p < 0.001), smaller step length (p = 0.015) and smaller locomotor rehabilitation index (p < 0.001) than HC., Conclusion: Individuals with end-stage ankle arthritis exhibit altered dynamic stability during gait, with a significantly smaller AP MoS on the non-arthritic limb at heel-strike and greater ML MoS on the arthritic limb at midstance compared to healthy controls. Our results suggest that individuals with ankle arthritis are less stable when navigating single limb support of the arthritic limb. Further research should further examine the associations with fall risk in patients with ankle arthritis and evaluate the effectiveness of therapeutic interventions targeting these factors., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: There is limited data showing the benefit of liposomal bupivacaine as part of an Enhanced Recovery After Surgery (ERAS) protocol in reducing opioid use in minimally invasive lobectomies., Methods: A retrospective observational study compared 3 cohorts of patients who underwent lobectomies between January 2015 and December 2021. The control group neither received liposomal bupivacaine intraoperatively nor underwent an ERAS protocol. The liposomal bupivacaine cohort only received a nerve block, whereas the ERAS cohort received a nerve block intraoperatively and underwent an ERAS protocol. The primary outcome was postoperative opioid consumption., Results: The study included 433 patients, comprising 87 in the control group, 138 in the liposomal bupivacaine alone cohort, and 208 in the ERAS/liposomal bupivacaine cohort. There was a statistically significant difference in the amount of opioids used between the control (43 oral morphine equivalents [OME]) and liposomal bupivacaine alone cohort (30.5 OME; P < .001), between control vs the ERAS/liposomal bupivacaine cohort (17 OME; P < .001), and between the liposomal bupivacaine alone and ERAS/liposomal bupivacaine cohorts (P < .001). Hospital stay was not statistically different between the 2 groups of interest (3 days); however, hospital stay differed from the control (4 days). Readmission at 30 days was not significantly different between the 3 groups (P = .43)., Conclusions: Liposomal bupivacaine alone as part of a larger ERAS protocol significantly reduced opioid use and hospitalization duration; however, the reduction in opioid use was much greater with incorporation of liposomal bupivacaine into an ERAS protocol rather than in isolation. Prospective studies are needed to determine reproducibility and applicability of liposomal bupivacaine for opioid use reduction in other United States hospital systems., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To highlight median arcuate ligament syndrome as a potential cause for celiac artery stenosis and pancreaticoduodenal artery aneurysm, and describe treatment options in this setting., Case Report: A 63-year-old male presented with a pancreaticoduodenal artery aneurysm and concomitant celiac artery stenosis that was treated with celiac artery stenting and aneurysm coiling. He subsequently developed stent fracture and celiac artery occlusion secondary to previously unrecognized median arcuate ligament syndrome causing reperfusion of the aneurysm. This was treated with open median arcuate ligament release and aorta to common hepatic artery bypass with good clinical result and stable 20-month surveillance imaging., Conclusion: It is critical to recognize median arcuate ligament syndrome as a cause of celiac artery stenosis in the setting of pancreaticoduodenal artery aneurysm given the high risk of failure of endovascular stenting. Open aorto-hepatic artery bypass and endovascular aneurysm coiling should be the preferred approach in these patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Nationally, the volume of geriatric falls with intracranial hemorrhage is increasing. Our institution began observing patients with intracranial hemorrhage, Glasgow Coma Scale of 14 or greater, and no midline shift or intraventricular hemorrhage with hourly neurologic examinations outside of the ICU in a high observation trauma (HOT) protocol. We first excluded patients on anticoagulants or antiplatelets (HOT I), then included antiplatelets and warfarin (HOT II), and finally, included direct oral anticoagulants (HOT III). Our hypothesis is that HOT protocol safely reduces ICU use and creates cost savings in this patient population., Study Design: Our institutional trauma registry was retrospectively queried for all patients on HOT protocol. Patients were stratified based on date of admission (HOT I [2008-2014], HOT II [2015-2018], and HOT III [2019-2021]), and were compared for demographics, anticoagulant use, injury characteristics, lengths of stay, incidence of neurointervention, and mortality., Results: During the study period, 2,343 patients were admitted: 939 stratified to HOT I, 794 to HOT II, and 610 to HOT III. Of these patients, 331 (35%), 554 (70%), and 495 (81%) were admitted to the floor under HOT protocol, respectively. HOT protocol patients required neurointervention in 3.0%, 0.5%, and 0.4% of cases in HOT I, II, and III, respectively. Mortality among HOT protocol patients was found to be 0.6% in HOT I, 0.9% in HOT II, and 0.2% in the HOT III cohort (p = 0.33)., Conclusions: Throughout the study period ICU use decreased without an increase in neurosurgical intervention or mortality, indicating the efficacy of the HOT selection criteria in identifying appropriate candidates for stepdown admission and HOT protocol., (Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

We report on developing three flashlamp-pumped electro-optically Q-switched Cr:Er:YSGG lasers with the Q-switch based on a La 3 Ga 5 SiO 14 crystal. The "short" laser cavity was optimized for high peak power applications. In this cavity, 300 mJ output energy in 15 ns pulses at a 3 Hz repetition rate was demonstrated with pump energy below 52 J. However, several applications, such as Fe:ZnSe pumping in a gain-switched regime, require longer (∼ 100 ns) pump pulse duration. We developed a 2.9 m long laser cavity that delivers 190 mJ of output energy in 85 ns pulses for these applications. We also demonstrated the Cr:Er:YSGG MOPA system producing 350 mJ output energy at 90 ns pulse duration and 47.5 J of pumping, corresponding to an amplification factor of 3.

Introduction: The role of thoracic endovascular aortic repair (TEVAR) in patients with Marfan Syndrome with Stanford type B aortic dissection (TBAD) remains under debate., Evidence Acquisition: MEDLINE and EMBASE were searched through December 2021 to identify studies that investigated outcomes in MFS patients with TBAD who underwent TEVAR. Data regarding patient characteristics, perioperative and late outcomes were extracted., Evidence Synthesis: Twelve studies were identified including 120 patients. The mean age was 40.2 years (95% confidence interval [CI], 36.8-43.6). 40.4% (95% CI: 10.8-70.0) of cases were performed emergently. 76.2% (95% CI: 64.6-87.8) of patients had a history of previous aortic surgery. In-hospital mortality was 3.7% (95% CI: 0.6-6.8). Primary endoleak occurred in 15.2% (95% CI: 8.6-21.8), which was comprised of type 1 (9.3% [95% CI: 3.9-14.6]) and type 2 (7.1% [95% CI: 2.3-12.0]) endoleaks. During mean follow-up period of 37.4 months (95% CI: 24.1-50.7), secondary endoleak was reported in 14.1% (95% CI: 7.1-21.1), which was comprised of type 1 (7.4% [95% CI: 2.4-12.5]) and type 2 (4.0% [95% CI: 0.3-7.7]) endoleak. Repeat TEVAR was performed in 15.5% (95% CI: 9.3-21.8) and open aortic surgery in 18.6% (95% CI: 9.6-27.5). Long-term mortality was 11.9% (95% CI: 6.5-17.3)., Conclusions: Our analysis showed that TEVAR for TBAD in patients with MFS has low perioperative morbidity and mortality but was associated with a high rate of late reintervention. This treatment option should be limited to emergent cases and to patients deemed unsuitable for open repair. Lifelong follow-up with imaging is mandatory in this population.

Introduction: The American College of Rheumatology (ACR) criteria, and more recently the revised ACR criteria (rACR), are a scoring system developed to aid in the diagnosis of giant cell arteritis (GCA). Our aim was to investigate the value of the non-biopsy criteria of the original ACR criteria and rACR criteria to predict GCA, and investigate the utilization of such scores to avoid biopsy when a very high or very low likelihood of a positive temporal artery biopsy TAB was predicted. Method: We conducted a retrospective cohort study of 59 patients undergoing TAB from 2013 to 2017 in Beaumont Hospital, a tertiary referral centre in Dublin, Ireland. Demographic data, biochemical results, presenting features, and histology results were collected and collated. Results: Data were analysed from 53 patients and ACR scores were compiled. Seventeen scored < 3 and thirty-six scored 3−5. All 11 positive biopsies were in the 3−5 score range. Forty-five patients were analysed with rACR scores. Eight were excluded due to not meeting the inclusion criteria. Of the 11 positive biopsies, 2 were in the 3−4 score range, and 9 were in the ≥5 score range. In the ACR method, 36% of all biopsies scored as low-risk pre-biopsy. In the rACR method, 84.4% of all biopsies scored in the low- and intermediate-risk group pre-biopsy and 15.6% of all biopsies scored in the high-risk group pre-biopsy. Conclusions: This study illustrates the potential value of the rACR scoring system as a useful tool to categorize patients according to risk with a view to avoiding unnecessary TAB. The data suggest that a TAB has a helpful role in low- and intermediate-risk groups but is of minimal benefit in the high-risk group.

Background: Limited evidence suggests the efficacy of animal-assisted activities (AAA) in improving biobehavioral stress responses in older patients in intensive care units (ICUs)., Objectives: To assess the feasibility of an AAA (dog) intervention for improving biobehavioral stress response, measured by self-reported stress and anxiety and salivary cortisol, C-reactive protein, and interleukin-1β in older ICU patients, we examined enrollment, attrition, completion, data collection, and biobehavioral stress responses., Methods: ICU patients ≥60 years old were randomly assigned to a 10-min AAA intervention or control/usual ICU care. Attitudes toward pets were assessed before the intervention. Self-reported stress and anxiety and salivary stress biomarkers were collected before and after the intervention and the usual care condition., Results: The majority of patients were ineligible due to lack of decisional capacity, younger age, inability to provide saliva specimens, or critical illness. Though 15 participants were randomly allocated (AAA = 9; control = 6), only 10 completed the study. All participants completed the questionnaires; however, saliva specimens were significantly limited by volume. AAA was associated with decreases in stress and anxiety. Biomarker results were variable and revealed no specific trends associated with stress responses. Conclusions : Barriers to recruitment included an insufficient number of patients eligible for AAA based on hospital policy, difficulty finding patients who met study eligibility criteria, and illness-related factors. Recommendations for future studies include larger samples, a stronger control intervention such as a visitor without a dog, greater control over the AAA intervention, and use of blood from indwelling catheters for biomarkers.

Episiotomy is an enlargement of the vaginal orifice made by a surgical incision of the perineum. This review aimed to provide a socio-historical retrospective on the practice or episiotomy. Using the criteria from the PRISMA guidelines, the authors conducted a literature review, browsing twenty databases and several papers available in the gray literature. Sixty-four articles, seven reports, and fifteen books were selected. Through this study, four eras with different approaches to episiotomy practice could be identified: 1792-1920, 1920-1980, 1980-1996, and 1996-2018. This review shows that institutionalization and medicalization of birth lead to a systematic practice of episiotomy in many westernized countries until 1996. Lay questioning and evidence-based medicine may have reversed this trend into a restrictive practice. After making an inventory of the factors associated with the evolution of change in the rate of episiotomies, the review finally revealed that evolution of the practice of episiotomy has also been influenced by ideological, political, and social factors.

Episiotomy practice is influenced by many factors studied in the scientific literature. Evidence-based medicine has isolated many factors that are linked to episiotomy practice, thus creating a need to group all these factors to create a relevant and useful database for scientific research. Based on the PRISMA methodology, the authors conducted a systematic literature review with the aim of covering this very need. Using 12 French and English combinations of relevant keywords, 15 databases containing publications published between 2008 and 2018 were evaluated. A total of 63 articles were identified, grouped and categorised into four main themes in the results section: (1) Individual and clinical factors related to the mother, (2) individual and clinical factors related to the child, (3) technical factors, and (4) organisation of health care and professional factors (institutional, organisational, personal and professional factors). These factors are then presented in terms of their impact on the practice of episiotomy. Then the future implications of this study on scientific research and clinical practice are discussed.

First described at the beginning of the 1970s, the concept of birth medicalisation has experienced a theoretical and ideological evolution influenced by the lines of research that have been associated with it. This evolution has given rise to different schools of thought concerning medicalisation, but also various methodologies used in different scientific fields. It seems relevant to propose a global synthesis of the various lines of thought related to birth medicalisation. To do this, the authors conducted a systematic literature review based on the PRISMA method. With a total of 38 occurrences in French and English, the authors scrutinised 17 databases with a publication period between 1995 and 2018. A total of 112 documents (107 articles, 3 book chapters, 2 books) has been identified, grouped and categorised into five main themes in the results section (1) the theoretical evolution of the concept of medicalisation, (2) factors related to the birth medicalisation, (3) the impact of the birth medicalisation, (4) the humanisation of birth and (5) experiences related to childbirth. A reasoned synthesis of the literature is therefore carried out in each part and then discussed according to the selected lines of research that require development in order to guarantee the best possible accompaniment to women who give birth., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The authors' purpose for this article is to identify, review and interpret all publications about the episiotomy rates worldwide. Based on the criteria from the PRISMA guidelines, twenty databases were scrutinized. All studies which include national statistics related to episiotomy were selected, as well as studies presenting estimated data. Sixty-one papers were selected with publication dates between 1995 and 2016. A static and dynamic analysis of all the results was carried out. The assumption for the decline in the number of episiotomies is discussed and confirmed, recalling that nowadays high rates of episiotomy remain in less industrialized countries and East Asia. Finally, our analysis aims to investigate the potential determinants which influence apparent statistical disparities.

Since its creation, the practice of episiotomy has evolved, being influenced by several factors. Various stances on its use were stated, until the eventual reduction of this practice, as suggested by numerous practical guides. In 2005, the National College of Obstetricians and Gynecologists in France published its French Guidelines for Clinical practice in this area. Today, it seems appropriate to focus on the evolution of the use of episiotomy, ten years after the publication of these recommendations. The authors propose a literature review, browsing through all the available epidemiological data in France related to episiotomy, recording all national statistics and some local trends, as there are regional specificities. This review allows to follow the overall evolution of the practice of episiotomy in France between 1981 and 2014, and to identify territorial disparities. Finally, in the specific context of the practice of episiotomy in French gynecological and obstetrics field, the authors conclude it by considering the possible evolution of this surgical practice, as well as, the Clinical Practice Recommendations related to it., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Primary cilia play a role in the sensation of and response to the surrounding environment. Caenorhabditis elegans (C. elegans) have primary cilia only on the distal tips of some dendrites. In order to better understand the relationship between receptor localization to cilia, cilia structure and cilia function, we have characterized a mutation originally identified in a forward genetic screen for mutants with defective PKD-2 ciliary localization. Through behavioral assays and examination of the structure of cilia in the cil-5 (my13) mutant animals, we have found that my13 disrupts not only receptor localization, but also some cilia-mediated sensory behaviors and cilia structural integrity. We have identified the my13 lesion and found that it is a missense mutation in bbs-7, an ortholog of human BBS-7, a gene known to affect human cilia and to be involved in Bardet-Biedl syndrome. Finally, we show that bbs-7(my13) also affects the glia cells which support the cilia.

Mechanically ventilated patients in the intensive care unit (ICU) are typically turned manually by nursing staff to reduce the risk of developing ventilator associated pneumonia and other problems in the lungs. However, turning can induce changes in the heart rate and blood pressure that can at times have a destabilizing effect. We report here on the early stage of a study that has been undertaken to measure the cardiovascular impact of manual turning, and compare it to changes induced when patients lie on automated beds that turn continuously. Heart rate and blood pressure data were analyzed over ensembles of turns with autoregressive models for comparing baseline level to the dynamic response. Manual turning stimulated a response in the heart rate that lasted for a median of 20 minutes and was of magnitude 5 to 13 bpm. The corresponding response in mean arterial pressure was 11 to 19 mm Hg, lasting for 8 to 21 minutes. There was no discernible response of either variable to automated turns.

Two pulsed neodimium yittrium aluminum garnet (Nd:YAG) laser systems were evaluated for contact surgery through a fiberoptic system with a sapphire tip. Pulsed Nd:YAG laser at 1060 nm was as effective as continuous-wave Nd:YAG laser in producing tissue incisions. A combination of 1060-nm and 530-nm wavelengths achieved smooth cutting at lower energy levels. Corneal endothelial cell damage occurred at the high power level (7 watts) required for smooth underwater incisions with both continuous wave and pulsed lasers.