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This chapter discusses the Tirmaga-Chai language recorded among the Suri people living in Southwest Ethiopia near the border of South Sudan. Dizi, Suri (Kacipo-Balesi), and Amharic are the languages with the most contact with Suri, especially with Amharic as the language of wider communication in Ethiopia. The Tirmaga-Chai, and Suri Woreda representatives have chosen their orthography based on a modified Roman script with the indication of grammatical tone. Tirmaga-Chai has an inventory of 22 consonants and 7 vowels which have suprasegmental features such as vowel length, gemination and tone. The language is fairly polysynthetic with most morphemes being agglutinative, although some are fusional. It predominately has SVO word order and is considered to be a nominative-accusative language.

Purpose The purpose of this paper is to explore the contextual and linguistic challenges that French business schools face when preparing for international accreditation and to shed light on the different ways in which experts facilitate these accreditation processes, particularly with respect to how they capitalize on their contextual and linguistic boundary-spanning competences. Design/methodology/approach The authors interviewed 12 key players at four business schools in France engaged in international accreditations and in three specific categories: senior management, tenured faculty and administrative staff. The interview-based case study design used semi-structured questions and an insider researcher approach to study an underexplored sector of analysis. Findings The findings suggest that French business schools have been particularly impacted by the colonizing effects of English as the mandatory language of the international accreditation bodies espousing a basically Anglophone higher education philosophy. Consequently, schools engage external experts for their contextual and linguistic boundary-spanning expertise to facilitate accreditation processes. Originality/value The authors contribute to language-sensitive research through a critical perspective on marginalization within French business schools due to the use of English as the mandatory lingua franca of international accreditation processes and due to the underlying higher-education philosophy from the Anglophone academic sphere within these processes. As a result, French business schools resort to external experts to mediate their knowledge and competency gaps.

Mucins are vital components contributing to the unique lubrication properties of human whole saliva. For patients receiving medication and or treatment such as diabetes or radiotherapy, xerostomia (dry mouth) is a common with numerous and deleterious side effects. Although products exist on the market to relive the symptoms of Xerostomia there remains a drive to formulate a biocompatible lubricant that replicate the functionality offered by the natural biological environment. Herein, a combination of mucin and thiolated polyethylene glycol (PEG-SH) was proposed as a new saliva substitute. Mucin and PEG-SH molecules could form hydrated layers immediately by chemisorption. Meanwhile, the chemical interactions between mucin and PEG-SH molecules also promoted the formation of a mixed layer. All the pre-formed layers could decrease friction and had the potential to decrease wear, especially mucin and PEG-SH mixed layer when compared to mucin only solutions. Further investigations of tribological mechanism implied that the excellent lubrication performance of mixed layer with long effectiveness was contributed to the friction-reducing effect of PEG/mucin molecules and the mucoadhesive property of mucin. The study provides a guide for using mucin as a mucoadhesive agent to stable lubricative polymers with low molecular weight as novel salivary substitutes for lubrication.

Survival outcomes of grade group 5 (GG5) prostate cancer (PCa) after standard of care therapy (SOC) remain poor. Evidence suggest that high dose rate brachytherapy (HDR) and androgen depravation therapy (ADT) can serve as immune modulators. We hypothesize that the combination of HDR, ADT, and immune checkpoint inhibitors (ICI) may synergize to improve immune response and disease control. Here we report an interim analysis of a single-center single-arm phase II trial exploring this novel combination therapy with nivolumab for GG5 PCa. Patients were enrolled from 9/2018 to 4/2021 and required to have GG5 PCa with > 30% positive cores and receive ICI plus SOC regimen, comprising ADT, external beam RT (EBRT), and HDR. ICI (240 mg) was administered every 2 weeks for 4 doses beginning 4 weeks prior to HDR. HDR consisted of two 1150 cGy implants. EBRT followed HDR and consisted of 4500 cGy in 25 fractions. Total ADT length and elective nodal radiotherapy were per physician discretion. Biopsies were taken at time of diagnosis, HDR, and 1-month post HDR. Biopsy tumor samples underwent genomic profiling. Major pathologic response (MPR) was defined as < 17% positive cores. Wilcoxon test and Area Under the Curve (AUC) Receiver Operating Characteristics (ROC) curves were used for statistical analyses. Toxicity was evaluated according to CTCAE v5.0. The historic control cohort consisted of all patients treated with SOC between 1/2013 to 11/2021 and met all study inclusion/exclusion criteria. Cox regression was used to calculate 2-year (2Y) risk of metastasis with censorship at 24 months (m). Median follow up (mFUP) defined from diagnostic biopsy. Of 34 patients who received 2 or more doses of ICI, 1 patient (3%) experienced a dose limiting toxicity of autoimmune hepatitis (AH). The incidence of all grade 3 toxicity related to ICI at 3 and 6 months were both 3% (n=1; AH and QT prolongation, respectively). There was no grade 4+ toxicity at 3 m, nor any grade 3+ toxicity at 6 m. Two subjects were withdrawn from study, leaving 32 evaluable for clinical outcomes. mFUP of ICI cohort was 32 m with a 2Y PSA failure rate of 6%. CD8A, STING, ANPEP, and multiple immune signatures were associated with an early MPR (p < 0.05) with ICI. The Ricketts_Immunosuppression genomic signature strongly correlated with MPR to ICI (AUC = 0.7, p = 0.01). The control cohort consisted of 59 patients with a mFUP of 35 m and a 2Y PSA failure rate of 19%. ICI demonstrated an 88% reduction in 2Y risk of metastasis compared to controls (HR = 0.12, 95% CI, 0.02 - 1.0, p = 0.05). Combination of ICI with SOC for GG5 PCa is safe and associated with a clinically significant improvement in disease control. Key genomic features were identified to predict for early MPR to ICI. Ricketts_Immunosuppression was identified as a potential biomarker for ICI-sensitive tumor subtypes. Final analyses are anticipated in late 2023. Clinical trial information: NCT03543189. Citation Format: John Michael Bryant, Maria Sandoval, Ryan Putney, Corrado Caslini, Shivanshu Awasthi, Esther Katende, Angelina Fink, Syeda Mahrukh H Naqvi, Youngchul Kim, Jingsong Zhang, Jong Park, Amparo Serna, Julio Pow-Sang, Michael Poch, Roger Li, Brandon Manley, Arash Naghavi, Javier Torres-Roca, G. Daniel Grass, Sungjune Kim, Kujtim Latifi, Dylan Hunt, Peter A. Johnstone, Jasreman Dhillon, Rohit Jain, Daniel Fernandez, Kosj Yamoah. Combination of nivolumab with standard of care in the management of grade group 5 prostate cancer: Interim analysis of a phase II trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT157.

Statistical methods are frequently built upon assumptions that limit their applicability to certain problems and conditions. Failure to recognize these limitations can lead to conclusions that may be inaccurate or biased. An example of such methods is the non-parametric Efron–Petrosian test statistic used in the studies of truncated data. We argue and show how the inappropriate use of this statistical method can lead to biased conclusions when the assumptions under which the method is valid do not hold. We do so by reinvestigating the evidence recently provided by multiple independent reports on the evolution of the luminosity/energetics distribution of cosmological Long-duration Gamma-Ray Bursts (LGRBs) with redshift. We show that the effects of detection threshold have been likely significantly underestimated in the majority of previous studies. This underestimation of detection threshold leads to severely incomplete LGRB samples that exhibit strong apparent luminosity-redshift or energetics-redshift correlations. We further confirm our findings by performing extensive Monte Carlo simulations of the cosmic rates and the luminosity/energy distributions of LGRBs and their detection process.

Lung cancer is the most common cause of cancer-related death in men, and the second most common one in women. The primary cause remains tobacco smoking, but there is an ongoing association with air pollution and specific carcinogens including radon, asbestos and coal fumes. The outcomes remain poor with fewer than one-in-five patients surviving 5 years after diagnosis. Lung cancer presents in several different ways; early recognition and diagnosis is essential to improve outcomes. Much of the work in general practice with patients who are suffering from lung cancer involves palliative care, and by managing patients well, GPs can have a big impact on patients’ last days of life.

The ability to replicate the load-bearing properties of articular cartilage is attractive for many engineering applications, particularly bearings where low friction, low wear, and high durability are required. Hydrogels are widely used materials spanning many diverse applications owing to their lubricity and unique mechanical/chemical properties. The poor mechanical characteristics of conventional hydrogels, especially their compressive behavior, limit their application in load-bearing applications despite their favorable properties such as poro/viscoelasticity and lubricity. This paper demonstrates a cartilage-inspired approach to produce a structure that benefits from water-swelling resistant and ultrafast recovery behavior of elastomers as well as the stress-relaxation and energy dissipation properties of hydrogels. A method is presented in this work to fabricate interconnected macro-porous elastomers based on sintering poly(methyl methacrylate) beads. The porous elastomer imparted structural support and resilience to its composite with an infused-grafted hydrogel. At 30% strain and depending upon the strain rate, the composite exhibited a load-bearing behavior that was 14–19 times greater than that of pristine hydrogel and approximately 3 times greater than that of the porous elastomer. The equilibrium elastic modulus of the composite was 452 kPa at a strain range of 10%–30%, which was close to the values reported for the modulus of cartilage tested with similar experimental parameters defined in this study. The dissipated energy for the composite at strain rates of 1 and 10–3 s–1 was enhanced by 25-, 25-, 5-, and 15-fold as compared to that for the pristine hydrogel and the porous elastomer, respectively. The cyclic loading tests at two strain rates showed that the composite immediately recovers its load-bearing properties with the maximum load recovery staying above 95% of its initial values throughout the testing. The permeability of the structures was measured experimentally, and the results showed a decrease of permeability by 3 orders of magnitude following hydrogel grafting.

Titanium cermet combining metallic toughness with ceramic wear resistance has been proven to be a potential candidate for implanted joint material. In this work, titanium cermet was synthesized by means of the elevated temperature solid carburizing technology. The Ti13Nb13Zr alloy surface was found to be converted into TiC ceramic layer combined with a carbon strengthened diffusion zone underneath. The overall thickness of the carburized region grew to about 100 µm after 120 min carburization at 1,500 K. In order to clarify the growth behaviors of TiC ceramic layer, a growth mechanism is proposed. At the beginning of carburizing process, carbonaceous gas decomposed from carburizer due to high temperature and then converted to free atomic carbons through reduction reaction. Then, in-situ generated TiC ceramic layer possessing certain thickness formed on the surface, meanwhile, the inner carbon diffusion zone also grew inwards due to physical diffusion of carbon, and finally forming a gradient carbon distribution. In addition, the tribological behaviors of the new materials were evaluated through reciprocating ball-on-plate sliding wear tests in bovine calf serum. Although there was an increase in friction coefficient, the wear rate decreased by 59.6% due to the formation of the wear-resistant TiC ceramic layer. The wear mechanisms evolved from severe abrasive wear for bare Ti13Nb13Zr alloy to mild adhesive wear for titanium cermet.

Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead of healthy tissue. Magnetic resonance imaging (MRI) offers improved soft-tissue visualization, allowing for better tumor and normal tissue delineation. MR-guided RT (MRgRT) has traditionally been defined by the use of offline MRI to aid in defining the RT volumes during the initial planning stages in order to ensure accurate tumor targeting while sparing critical normal tissues. However, the ViewRay MRIdian and Elekta Unity have improved upon and revolutionized the MRgRT by creating a combined MRI and linear accelerator (MRL), allowing MRgRT to incorporate online MRI in RT. MRL-based MR-guided SBRT (MRgSBRT) represents a novel solution to deliver higher doses to larger volumes of gross disease, regardless of the proximity of at-risk organs due to the (1) superior soft-tissue visualization for patient positioning, (2) real-time continuous intrafraction assessment of internal structures, and (3) daily online adaptive replanning. Stereotactic MR-guided adaptive radiation therapy (SMART) has enabled the safe delivery of ablative doses to tumors adjacent to radiosensitive tissues throughout the body. Although it is still a relatively new RT technique, SMART has demonstrated significant opportunities to improve disease control and reduce toxicity. In this review, we included the current clinical applications and the active prospective trials related to SMART. We highlighted the most impactful clinical studies at various tumor sites. In addition, we explored how MRL-based multiparametric MRI could potentially synergize with SMART to significantly change the current treatment paradigm and to improve personalized cancer care.

Powder mixed-electro discharge machining (PM-EDM) is recently evolving machining technique which can simultaneously remove and modify the machined surface through thermo-electrical process. It is a modified form of EDM in which the conductive powder elements are added in the dielectric liquid to enhance machined surface characteristics and machining responses. The commonly used biomaterials such as 316L stainless steel, Ti-based alloy, Ni–Ti, Mg alloy, and Co–Mo–Cr alloy have excellent mechanical characteristics while the biofunction of these materials are not in satisfactory level. Due to higher hardness, brittleness, and heat resistant natures of the biomaterials, it is very challenging to machine them with conventional machining. Both the system efficiency and modified surface properties depend on the associated electrical and non-electrical factors of PM-EDM cycle. This review focuses on the influence of process factors such as current, pulse duration, tool-polarity, duty cycle, potential voltage, types of liquid, and added powder concentration on performance outputs including material removal and tool wear rate, coating thickness, coarseness, microhardness, coating adhesion bonding, biocompatibility, and resistant to corrosion. This study also discusses influence of various powders on machining and modified surface characteristics of biomaterials. The future research scopes and challenges of PM-EDM process are included in this study thoroughly.

Oral friction on the tongue surface plays a pivotal role in mechanics of food transport, speech, sensing, and hedonic responses. The highly specialized biophysical features of the human tongue such as micropapillae-dense topology, optimum wettability, and deformability present architectural challenges in designing artificial tongue surfaces, and the absence of such a biomimetic surface impedes the fundamental understanding of tongue-food/fluid interaction. Herein, we fabricate for the first time, a 3D soft biomimetic surface that replicates the topography and wettability of a real human tongue. The 3D-printed fabrication contains a Poisson point process-based (random) papillae distribution and is employed to micromold soft silicone surfaces with wettability modifications. We demonstrate the unprecedented capability of these surfaces to replicate the theoretically defined and simulated collision probability of papillae and to closely resemble the tribological performances of human tongue masks. These de novo biomimetic surfaces pave the way for accurate quantification of mechanical interactions in the soft oral mucosa.

Poly(vinyl chloride) (PVC) biomaterials perform a host of life-saving and life-enhancing roles when employed as medical devices within the body. High frictional forces between the device surface and interfacing tissue can, however, lead to a host of complications including tissue damage, inflammation, pain and infection. We herein describe a versatile surface modification method using multifunctional hydrogel formulations to increase lubricity and prevent common device-related complications. In a clinically-relevant model of the urinary tract, simulating the mechanical and biological environments encountered in vivo, coated candidate catheter surfaces demonstrated significantly lower frictional resistance than uncoated PVC, with reductions in coefficient of friction values of more than 300-fold due to hydration of the surface-localised polymer network. Furthermore, this significant lubrication capacity was retained following hydration periods of up to 28 days in artificial urine at pH 6 and pH 9, representing the pH of physiologically normal and infected urine respectively, and during 200 repeated cycles of applied frictional force. Importantly, the modified surfaces also displayed excellent antibacterial activity, which could be facilely tuned to achieve reductions of 99.8% in adherence of common hospital-acquired pathogens, Staphylococcus aureus and Proteus mirabilis, relative to their uncoated counterparts through incorporation of chlorhexidine in the coating matrix as a model antiseptic. The remarkable, and pH-independent, tribological performance of these lubricious, antibacterial and highly durable surfaces offers exciting promise for use of this PVC functionalization approach in facilitating smooth and atraumatic insertion and removal of a wide range of medical implants, ultimately maintaining user health and dignity.

Powder mixed-electro discharge machining (PM-EDM) is a new emerging trend in research on electro-thermal process that can simultaneously shape and deposit a coating on the surface of the workpiece....

Powder mixed-EDM is a newly emerging proposed manufacturing process which can simultaneously shape and coat the surface of conductive materials. Transformation of machined surface is occurred throu...

Fretting-corrosion at the modular taper junction in total hip replacements (THR), leading to implant failure, has been identified as a clinical concern and has received increased interest in recent years. There are many parameters thought to affect the performance of the taper junction, with the assembly process being one of the few consistently identified to have a direct impact. Despite this, the assembly process used by surgeons during THR surgery differs from a suggested ‘ideal’ process. For example, taper junctions of cutting tools should be pushed together rather than impacted, while ensuring as much concentricity as possible between the male and female taper and loading axis. This study devised six simple assembly methodologies to investigate how surgical variations affect the success of the compressive fit achieved at the taper interface compared to a controlled assembly method, designed to represent a more ‘ideal’ scenario. Key findings from this study suggest that a more successful and repeatable engagement can be achieved by quasi-statically loading the male and female taper concentrically with the loading axis. This was shown by a greater disassembly to assembly force ratio of 0.626 ± 0.07 when assembled using the more ‘ideal’ process, compared to 0.480 ± 0.05 when using a method closer to that used by a surgeon intraoperatively. Findings from this study can be used to help inform new surgical instrumentation and an improved surgical assembly method.

The formation of tribochemical reaction layers, better known as tribofilms, on cobalt-chromium-molybdenum (CoCrMo) alloys commonly used in orthopaedic applications has been hypothesized to reduce degradation owing to wear and corrosion. However, the mechanisms and pathways influencing tribofilm formation remain largely unknown. This study aims to develop a clearer understanding of the role of protein structures and its concentration on tribocorrosion and surface tribofilms formed on CoCrMo alloys during boundary regime sliding. A reciprocating tribometer with a three-electrode electrochemical cell was employed to simulate and monitor the tribocorrosion of CoCrMo in situ. As-received Foetal Bovine Serum (as-FBS) and pre-heated FBS at 70 °C for 1 h (de-FBS) were diluted with saline (0.9% NaCl) at different concentrations (25% and 75% v/v) and utilized as electrolytes during the tribocorrosion tests. The result shows that the denatured protein structure in electrolyte tends to reduce the volume losses due to wear and corrosion on the CoCrMo samples with an appreciation of the protein tribofilms. On the other hand, an increased protein concentration increased the total volume loss due to corrosive processes. A novel finding revealed in this study is that the tribocorrosion mechanism of the CoCrMo surface is dependent on the protein structure, concentration and sliding duration due to the change in surface condition.

Following the high clinical failure rates of metal-on-metal total hip replacements much work has been undertaken to investigate their poor performance. So called adverse loading scenarios such as acetabular inclination and microseparation have been attributed to indicators for failure of the implants. The ISO hip simulation standards (ISO 14242:1) still rely on gravimetric and ex situ analysis, considering only the total wear during articulation. Live in situ sensing can provide valuable insight into the degradation mechanisms of metallic interfaces under such scenarios. Clinical 28 mm diameter metal-on-metal components were articulated in a full-ISO hip simulator. The bearings were subjected to increasing angles of acetabular inclination and retroversion over short-term periods of articulation. Corrosive degradation was monitored during sliding by means of an in situ three-electrode cell. Changing acetabular inclination from 30° to 50° resulted in greater cathodic shifts in OCP upon the initiation of sliding; from −50 mV to as much as −150 mV. Under anodic polarisation (0 mV vs. Ag/AgCl) the resultant currents at the initiation of sliding also increased significantly with inclination; from approximately 4–10 µA to over 120 µA. Increased retroversion of 20° also resulted in increased anodic currents of 55–60 µA. Changing the nature of articulation demonstrated increased corrosive material loss compared to a standard ISO 14242 profile. The sole use of gravimetric assessment to determine a wear rate for hip replacement bearings under simulation can therefore neglect important degradation mechanisms, such as tribocorrosive loss in devices with metal sliding interfaces.

In this paper, an asperity-scale electrochemical model is combined with a computational contact mechanics solution to simulate a tribocorrosion system. The proposed approach is unique, considering the real-time evolution of surface topography, wear and corrosion. The proposed framework facilitates the prediction of wear, corrosion and its synergies by de-coupling wear and corrosion processes; better representing the physical and chemical system. The model is able to determine the current on the micro scale and the summation of the asperity currents is assumed to define the macro-scale quantity of the current. The evolution of current from this model has been validated with experiments using a ball-on-plate tribometer. The findings are in very good agreement with the experiments. The numerical model directly calculates the real area of contact in a tribo-corrosive condition and highlights its importance in the electrochemical and mechanical wear. Investigating the effect of load also confirms that if the topography is evolved at different loading conditions, the electrochemical response of the system also evolves accordingly. After the model validation, the effect of mechanical wear on the corrosive wear has been computed and it suggests that the corrosive wear changes linearly with the mechanical wear.

Headaches are extremely common, affecting over 75% of school-aged children. Most are benign and resolve as the child grows older, particularly tension-type headaches. There is often a close interaction between the child’s headache and their environment and lifestyle. A detailed history is the key to making a diagnosis; it will also allow caregivers and children to express their concerns and identify red flag symptoms. A focussed neurological examination is also essential. Many headaches occur a secondary to other conditions, such as infections or injuries and these conditions should not be overlooked. Although the majority of these conditions can be addressed in primary care, GPs should be aware of when to refer and the appropriate urgency.

Shakespeare once said, ‘all the world’s a stage, and all the men and women merely players’. 1 This phrase has rung true throughout 2020 as I’ve juggled my role as an out-of-hours telemedicine doctor with my ‘other job’ (the entirely unpaid, 80 hours a week role) as the medical director of Eternal Love Winning Africa (ELWA) hospital in Liberia, a charity-run hospital in one of the world’s most resource-deprived countries. Every day sees a stream of children in extremis; tiny malnourished fingers reaching for packets of Plumpy’Nut, comatose toddlers held by mothers praying for renewed life to reach their eyes, neonates who arrived too soon to survive without the ventilators so emblematic of 2020. The team fight hard to save as many as possible, but most weeks we lose at least a couple. I dress in my best paediatrician scrubs and do my best to play the part — as a GP with a specialist interest, I’m the closest the ELWA has. The Royal College of Paediatrics and Child Health2 recently wrote a statement on the …