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Background and objective: Community participation or participatory planning are two terms used interchangeably that aim to incorporate community residents' opinions in the planning process to get the maximum benefit. This approach aims to gather stakeholders and engage them in a meaningful conversation to come to a decision representing the stake for everyone involved. This study focuses on the impacts of photorealistic visualization on community participation in the U.S. Great Lakes Region through a 5-year long (2017-2022) climate adaptation planning project conducted in Marquette County, Michigan, USA.Methods: Using the deliberation with analysis method of public participation, supported by visualizations, and followed by post-project surveys, the study explores how visualizations can improve in disseminating knowledge, bridging the gap of understanding among participants, enhancing engagement and delivering consistent approaches in the community decision-making process to come to a mutual ground of trust and common interest.Results: The study reveals that visualizations used at different phases of the community participation process increased participants' interest and engagement during the meeting, provided them with the necessary knowledge regarding climate change and its negative impact on health, and assisted them in decision-making and prioritizing design goals. The study also reveals that the visuals enhanced the project participants' engagement beyond the project's scope in future planning endeavors and increased their inclination towards climate and health adaptation planning.Conclusion: These findings will play a significant role in shaping the adaptive capacity in rural nonagricultural communities and strengthening the decision-making for similar areas dealing with climate change and its consequences.

Oblique lumbar interbody fusion is a minimally invasive procedure for treating degenerative lumbar disease. Its advantages include correcting coronal and sagittal spinal alignment and indirect neural decompression. However, achieving a successful outcome is limited in some patients who need direct decompression for central canal lesions including hard stenotic lesions (endplate or facet articular osteophytes and ossification of posterior longitudinal ligaments) and sequestration of the disk. Biportal endoscopic spinal surgery is a minimally invasive technique, which directly decompresses the lesion. By taking advantage of two procedures, in a longlevel lumbar lesion, alignment correction and direct decompression can be both achieved. Herein, the authors introduce multilevel lumbar fusion through oblique lumbar interbody fusion and selective direct decompression through biportal endoscopic spinal surgery and discuss the surgical indications, surgical pitfalls, and recommendations for application. Consequently, it is regarded as a minimally invasive interbody fusion method for patients with multilevel lumbar degenerative degeneration.

Background: Although competency-based education (CBE) is becoming a popular form of medical education, it has not been used to train residents. Recently, the Korean Society of Anesthesiologists completed a pilot implementation and evaluation of a CBE program.This study aims to outline the experience.Methods: The chief training faculty from each hospital took a one-hour online course about CBE. Emails on the seven core competencies and their evaluation were sent ahead of a pilot core competency evaluation (CCE) to residents and faculty. The pilot CCE took place in late 2021, followed by a survey.Results: A total of 68 out of 84 hospitals participated in the pilot CCE. The survey response rate was 55.9% (38/68) for chief training faculty, 10.2% (91/888) for training faculty, and 30.2% (206/683) for residents. More than half of the training faculty thought that CCE was necessary for the education of residents. Residents’ and training faculty’s responses about CCE were generally positive, although their understanding of CCE criteria was low. More than 80% of the hospitals had a defibrillator and cardiopulmonary resuscitation manikin while the rarest piece of equipment was an ultrasound vessel model. Only defibrillators were used in more than half of the hospitals. Thoughts about CCE were related to various factors, such as length of employment, location of hospitals, and the number of residents per grade. Conclusions: This study’s results may be helpful in improving resident education quality to meet the expectations of both teaching faculty and residents while establishing CBE.

This work demonstrates the rapid coating of gold nanoparticles (AuNPs) onto electrospun composite polyacrylonitrile (PAN) nanofibers containing a large amount of graphene oxide (GO) and reduced graphene oxide (rGO) for photothermally-driven applications. A modification of GO with a cationic surfactant greatly improves its loading efficiency into the PAN nanofibers, and the subsequent hydrazine treatment readily converts the integrated GO into rGO. Rapid loading of AuNPs onto these membranes results in measurably higher photothermal heating characteristics than the pristine PAN, GO-PAN, and rGO-PAN membranes under a solar-simulated light source. The light-induced heating properties are then utilized in the removal of organic dyes in an aqueous solution. While the GO-PAN and rGO-PAN membranes remove the dyes via physical adsorption, the AuNP-loaded membranes show an additional catalytic decomposition process, resulting in detectably faster removal rates. The degradation of the organic dyes is accelerated under a solar simulated light source due to the light-enhanced heating and photocatalytic properties of the integrated AuNPs. The ability to maximize the dual properties of these membranes can greatly reduce toxic organic pollutants, which can lead to the development of practical water purification systems under sunlight irradiation.

Drowsy driving is a common, but underestimated phenomenon in terms of associated risks as it often results in crashes causing fatalities and serious injuries. It is a challenging task to alert or reduce the driver’s drowsy state using non-invasive techniques. In this study, a drowsiness reduction strategy has been developed and analyzed using exposure to different light colors and recording the corresponding electrical and biological brain activities. 31 subjects were examined by dividing them into 2 classes, a control group, and a healthy group. Fourteen EEG and 42 fNIRS channels were used to gather neurological data from two brain regions (prefrontal and visual cortices). Experiments shining 3 different colored lights have been carried out on them at certain times when there is a high probability to get drowsy. The results of this study show that there is a significant increase in HbO of a sleep-deprived participant when he is exposed to blue light. Similarly, the beta band of EEG also showed an increased response. However, the study found that there is no considerable increase in HbO and beta band power in the case of red and green light exposures. In addition to that, values of other physiological signals acquired such as heart rate, eye blinking, and self-reported Karolinska Sleepiness Scale scores validated the findings predicted by the electrical and biological signals. The statistical significance of the signals achieved has been tested using repeated measures ANOVA and t-tests. Correlation scores were also calculated to find the association between the changes in the data signals with the corresponding changes in the alertness level.

Background and objective The mental health and wellness of university students has been a pressing concern in recent years in the US and is becoming an even larger issue due to the COVID-19 Pandemic. Numerous studies have supported the idea that the natural environment can have a positive impact on mental health, but only a few studies focus on the role of university outdoor campus environments on student’s mental health. The main purpose of this study is to investigate the correlations between university student mental health and their campus’s outdoor environment. Methods An online survey was designed and distributed to students at Michigan State University, USA. Students were asked questions about their overall mental well-being, as well as questions about their environmental perceptions, outdoor activity, views to nature through windows and safety concerns regarding their outdoor campus environment. Results The major findings indicate a significant difference in mental health scores for windows in living quarters, where students with living quarter windows had better mental health scores (MHS) than students without living quarter windows. This study also found a marginally significant difference in MHS for students with classroom windows. Other results of this study include a significant difference in MHS for students’ perception of safety on campus, outdoor work time, and perception of greenspace on campus. Conclusion Future campus planner, landscape architects, university planners, and student counselors will use this study to determine what kinds of outdoor spaces should be created and used to improve the well-being of students.

Interdisciplinarity is a critical component of creating a more sustainable built environment and improving student learning outcomes. Yet, learning interdisciplinarity and measuring it in higher education is challenging. This study implemented a diagnostic tool that allowed educators to measure how both disciplinary and interdisciplinary skills, knowledge, and values would grow in courses related to sustainable built environments. One school containing four different disciplines devoted to the built environment, was selected as the study area to collect emprical data. Pre- and post-semester surveys were conducted. Among 286 students, interdisciplinarity grew most among students within the school’s majors, while among students from outside the school majors interdisciplinary learning decreased. Though disciplinary learning outpaces interdisciplinary learning the closer students are to earning their bachelor’s or higher degrees. The result showed that students’ knowledge, values and skills differ depending on the majors, their affiliational context, and the year of classification. The result suggests that the timing of teaching interdisciplinary contents should be earlier. The diagnostic tool which measured pre- and post- course disciplinary and interdisciplinary knowledge, skills, and values related to sustainable built environment would also be applicable in other courses in higher education.

Background and objective The industrial crisis in Michigan, USA calls for the redevelopment of abandoned industrial sites into functioning public spaces. Neglected spaces have negative impacts on the surrounding communities, promoting aesthetic, safety, economic, and environmental issues. The purpose of this study was to explore and discuss the possible redevelopment of an underused site, with particular focus on its industrial site elements; quantitative measures were then applied to determine redevelopment's effects on the nearby community. Methods The Michigan Central Station in Detroit, Michigan, USA was selected as a case study. Landscape performance research methods were applied to quantitatively analyze the environmental, social, and economic benefits of reclaiming this abandoned industrial site and its various elements. Results The findings show that implementing the case study redesign would result in positive environmental impacts. These impacts include expanded areas of ecologically valuable land, a reduction in sulfur dioxide, and increases in carbon sequestration, retained stormwater, and the use of recycled contents. The case study redevelopment project would impact the surrounding economic context through savings on water treatment costs obtained from the use of retained stormwater, increased property values, and job creation. Furthermore, the redesign would also impact social aspects by increasing the available gathering spaces and public open areas and enhancing safety by adding sidewalks and bike lanes. Conclusion The findings of this study will help designers and planners recognize the value of reusing existing industrial sites instead of undertaking harmful demolition processes, eventually leading to more sustainable community designs.

Background: Local anesthetics systemic toxicity (LAST) is a grave complication of regional anesthesia that usually occurs immediately after local anesthetics injection. Here, we report on rare late-onset toxicity cases after supraclavicular brachial plexus blocks.Case: Two patients underwent surgery for radius fractures. We used lidocaine 100 mg and ropivacaine 150 mg for blocking and infused dexmedetomidine for intraoperative sedation. The 63-year-old male patient’s blood pressure dropped to 87/60 mmHg after 3 h 15 min after blocking. Ventricular fibrillation occurred 10 min later. After five defibrillations, electrocardiography showed ventricular tachycardia that was normalized through one cardioversion. The 54-year-old female patient’s heart rate decreased to 35 beats/min 2 h 30 min after blocking. Her vital signs returned to normal after administering atropine, ephedrine, epinephrine, and lipid emulsion.Conclusions: Physicians should remember that LAST may occur long after local anesthetic injection and be aware of factors that may adversely affect the course of LAST.

The reduction of gold ions using four different types of mild reducing agents was carried out in the presence of poly(n-isopropylacrylamide), PNIPAM, particles under light irradiation at room temperature. Simply controlling the concentration ratios of the gold ions to reductants allowed for the systematic formation of physically encapsulated gold nanoparticles (AuNPs) within the PNIPAM particles due to the presence of weak interactions between the guest AuNPs and host PNIPAM particles. After the examination of the structural and physical properties of the AuNPs and their loading efficiency, the composite particles were extensively utilized in the aerobic homocoupling of phenylboronic acid in EtOH to examine their catalytic properties associated with the rate of reaction, selectivity, and activation energy (Ea). All composite particles showed the highly selective formation of the biphenyl product and comparable Ea values, regardless of the size and distribution of the encapsulated AuNPs as catalysts. However, the way the AuNPs were formed within the PNIPAM particles notably influenced the rate of reaction. As such, developing a simple approach to optimize the encapsulation degree of AuNPs and their structural features in the presence of polymer particles can be applied to designing diverse metal-polymer composite particles for rapid and effective catalytic systems.

Plasmonic effects that enhance electric fields and amplify optical signals are crucial for improving the resolution of optical imaging systems. In this paper, a metal-based plasmonic nanostructure (MPN) is designed to increase the resolution of an optical imaging system by amplifying a specific signal while producing a plasmonic effect via a dipole nanoantenna (DN) and grating nanostructure (GN), which couple the electric field to be focused at the center of the unit cell. We confirmed that the MPN enhances electric fields 15 times more than the DN and GN, enabling the acquisition of finely resolved optical signals. The experiments confirmed that compared with the initial laser intensity, the MPN, which was fabricated by nanoimprint lithography, enhanced the optical signal of the laser by 2.24 times. Moreover, when the MPN was applied in two optical imaging systems, an indistinguishable signal that was similar to noise in original was distinguished by amplifying the optical signal as 106 times in functional near-infrared spectroscopy(fNIRS), and a specific wavelength was enhanced in fluorescence image. Thus, the incorporation of this nanostructure increased the utility of the collected data and could enhance optical signals in optics, bioimaging, and biology applications.

INTRODUCTION One of the most frequently performed anti-aging surgical procedures is thread facelift. Since the 2010s, thread lifts using absorbable polydioxanone (PDO) thread were developed and have become increasingly popular. This research aims to identify the changes in and the mechanisms of absorbable thread-lifting components, namely, PDO (polydioxanone) and PCL (polycaprolactone), with varied absorption periods in the body. METHODS Four different types of threads, namely, single-stranded thread, 4-stranded thread, 12-stranded thread, and barbed Cog thread, were used for each component. Histological changes in the thread and neighboring tissue of rat model were investigated for 2-week interval, and PCR was conducted for genes related to fibroblast proliferation including type 1α1 collagen, type 3α1 collagen, transforming growth factor beta 1 (TGF-β1). RESULTS An increase in the collagen formation in all types of PDO and PCL groups was observed during the first 12 weeks and decreased afterward. Collagen formation decreased later in the PCL thread group significantly than the POD group. PCL thread remained logner in the tissue for over a year regarding POD requiring around 24 weeks of absorption-degradation. A larger surface area between the thread and the tissue induces a greater response in the tissue, resulting in an increase in inflammatory cells, myofibroblasts, and fibroblasts. Results showed a similar pattern of increase in type 1α1 collagen and TGF-β in the PDO thread group. This suggests that TGF-β signal transduction leads to fibroblast proliferation that stimulates collagen formation and tissue re-formation. In contrast, only type 3α1 collagen increased in the PCL thread group. CONCLUSION More collagen formation and tissue responses are induced by PCL thread, remaining longer in the tissue than PDO, leading to more tissue tightening effects that is one of the most important points of face lifting. Morphological comparison of threads shows that not only an increase in surface area between thread and tissue but also multi-strand increase tissue response, which in turn increases tissue maintenance effects.

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) on the use of noninvasive ventilation (NIV) for acute respiratory failure (ARF) in pediatric patients.We searched PubMed, EMBASE, the Cochrane Central Register of Clinical Trials, and Clinicaltrials.gov with a last update on July 31, 2022.We included RCTs comparing NIV with any comparator (standard oxygen therapy and high-flow nasal cannula [HFNC]) in pediatric patients with ARF. We excluded studies performed on neonates and on chronic respiratory failure patients.Baseline characteristics, intubation rate, mortality, and hospital and ICU length of stays were extracted by trained investigators.We identified 15 RCTs (2,679 patients) for the final analyses. The intubation rate was 109 of 945 (11.5%) in the NIV group, and 158 of 1,086 (14.5%) in the control group (risk ratio, 0.791; 95% CI, 0.629-0.996; p = 0.046; I2 = 0%; number needed to treat = 31). Findings were strengthened after removing studies with intervention duration shorter than an hour and after excluding studies with cross-over as rescue treatment. There was no difference in mortality, and ICU and hospital length of stays.In pediatric patients, NIV applied for ARF might reduce the intubation rate compared with standard oxygen therapy or HFNC. No difference in mortality was observed.

This study assessed the cooling ranges of small greenspaces (SGs) along the edges of surrounding areas and identified the spatial cooling distance threshold. Five SGs in a natural preserved public area located in College Station, Texas, USA, and a reference site (Rf) were selected for this study. Air temperature data collection took six rounds from fall to early summer. In each round air temperature was collected three times during a day (i.e., 10 h, 13 h, and 16 h). Temperature sensing units (TVCs) and loggers recorded air temperature every second via a transect survey. The cooling distance was determined according to each SG’s radius: (1) the centroid of the SG (GC), (2) the edge of the SG (GE), (3) 1.25 times the radius away from the GC (1.25R), and (4) 1.5 times the radius away from the GC (1.5R). Our findings showed the SGs’ cooling effect (∆TRf−i) surpassed their edges in general. The cooling degrees at the GC were higher and dropped continuously from the GE to 1.25R ending with 1.5R showing the lowest. In fall, the SGs’ mean cooling degree exceeded 9.24% at 1.5R compared to Rf. In early summer, the SGs’ mean cooling effects decreased significantly while showing a very small difference between the measurement points. Our findings contribute to uncovering some specific design features with SGs to cooling down cities by applying advanced technology. Our findings will help designers, planners, researchers, and local government officials by providing an optimal landscape planning and design guide for mitigating urban heat.

This work demonstrates an effective strategy for preparing electrospun composite membranes consisting of polyacrylonitrile (PAN) nanofibers and a large amount of graphene oxide (GO) and reduced graphene oxide (rGO). Simple surface modification of GO with a cationic surfactant reliably results in the preparation of composite nanofibers as a function of GO content up to 30 wt%, which are subsequently transformed into membrane-type sheets via heat and pressure treatments. In addition, an in situ hydrazine treatment readily converts the integrated GO into rGO, which is confirmed by water contact angles, Raman, XRD, and infrared thermography. These series of composite membranes are then employed in the removal of methylene blue dye with and without solar-simulated light irradiation. The PAN–GO composite membranes possessing various oxygen-containing functional groups initially display higher decontamination capability of the dyes than PAN–rGO. Both composite membranes notably improve the removal of the dyes to over 90% in 3 h under the light irradiation where the degree of removal efficiency for the PAN–rGO composite membrane is detectably increased due to its enhanced photothermal heating property. Although integrating GO derivatives into polymer nanofibers is a challenging task due to their limited dispersity and miscibility, our developed approach readily results in the systematic loading of GO and rGO at a high-level content into PAN nanofiber membranes, allowing us to realize their general properties including photothermal heating properties for various applications.

Background Postoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. Methods We searched PubMed, MEDLINE, EMBASE, Cochrane Central Register, and ClinicalTrials.gov for randomized control trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay. Results Four RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in IV group. Epidural group showed lower VAS than IV group at 12 hours (mean difference -0.99 [95% CI: -1.52, -0.47], P = 0.001, I2 = 0%), at 24 hours (mean difference -0.65 [95% CI: -1.15, -0.16], P = 0.009, I2 = 0%), and 48 hours (mean difference -0.81 [95% CI: -1.61, -0.01], P = 0.046, I2 = 46%) after the surgery. Conclusion Epidural analgesia after the MIRPE had a better analgesic effect than IV analgesia from 12 hours to 48 hours after surgery, and AUC of VAS was lower in the epidural group. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.

Background: Giant lip hemangioma is a rare disease that may cause difficulty in preoxygenation and ventilation when using face masks and intubation during general anesthesia induction.Case: A laparoscopic cholecystectomy was planned for a 77-year-old woman. The patient had a giant lower lip hemangioma that was 12 x 5 x 5 cm, which made preoxygenation and ventilation through a face mask impossible and put her at risk of hemangioma rupture. We preoxygenated her through a high-flow nasal cannula (HFNC). Following propofol and succinylcholine administration, we intubated the patient with a video laryngoscope without desaturation, hemangioma rupture, or CO2 retention. Conclusions: HFNC is a useful tool when difficult intubation is expected in patients who have problems using conventional face masks.

Background This study aimed to evaluate the efficacy and safety of a topical antioxidant cream containing tocotrienol after 1064-nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for environment-induced skin pigmentation.Methods A split-face study was conducted between December 2020 and March 2021 in 26 patients (25 women and one man) who were treated with a 1064-nm picosecond Nd:YAG laser. On the right side of the face, an antioxidant cream containing tocotrienol was applied after picosecond laser treatment, and on the left side, only picosecond laser treatment was performed. We compared the right and left sides of the face at 4 weeks after laser treatment using an automatic skin analysis device to investigate skin pigmentation. The melasma severity scores of the two sides were evaluated before and 4 weeks after picosecond laser treatment.Results The skin pigmentation score showed a significant difference between pretreatment and 4 weeks after picosecond laser treatment on both sides of the face (P0.05).Conclusions Our results show that, for the treatment of environment-induced skin pigmentation, the application of a tocotrienol-containing antioxidant cream after 1064-nm picosecond laser treatment can provide good results without any complications.

In this paper, proposed plasmonic nanostructure is designed to increase the spatial resolution of optical imaging system by amplifying a specific signal while producing a plasmonic effect via a nanoantenna and grating nanostructure. We utilized antenna theory and grating structure to enable the surface plasmon effect and coupling electric field to be focused center of unit cell and enhance the optical signal of 785 nm wavelength. We confirmed that a proposed plasmonic nanostructure can be used to enhance electric fields in specific angle of incident light, 30° and attain a far-field gain of 1137, enabling a more finely resolved optical signal to be obtained. In experiment, the proposed plasmonic nanostructure was confirmed to enhance optical signal of laser by 2.24 times and also confirmed enhancing electric field using AFM. Moreover, when applied in functional near-infrared spectroscopy and fluorescence imaging systems, it was confirmed that an indistinguishable signal can be distinguished by amplifying the optical signal 76 times, and a specific wavelength can also be enhanced. Accordingly, the incorporation of these nanostructures should increase the utility of the collected data and enhance optical signals for applications in optics, bioimaging, and biology.