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The increased size and enhanced compliance of the aortic bulb—the enlargement of the ascending aorta—are believed to maintain blood flow in pinnipeds during extended periods of diastole induced by diving bradycardia. The aortic bulb has been described ex vivo in several species of pinnipeds, but in vivo measurements are needed to investigate the relationship between structure and function. We obtained ultrasound images using electrocardiogram‐gated transesophageal echocardiography during anesthesia and after atropine administration to assess the relationship between aortic bulb anatomy and cardiac function (heart rate, stroke volume, cardiac output) in northern fur seals (Callorhinus ursinus) and Steller sea lions (Eumetopias jubatus). We observed that the aortic bulb in northern fur seals and Steller sea lions expands during systole and recoils over the entire diastolic period indicating that blood flow is maintained throughout the entire cardiac cycle as expected. The stroke volumes we measured in the fur seals and sea lions fit the values predicted based on body size in mammals and did not change with increased heart rates, suggesting that greater stroke volumes are not needed for aortic bulb function. Overall, our results suggest that peripheral vasoconstriction during diving is sufficient to modulate the volume of blood in the aortic bulb to ensure that flow lasts over the entire diastolic period. These results indicate that the shift of blood into the aortic bulb of pinnipeds is a fundamental mechanism caused by vasoconstriction while diving, highlighting the importance of this unique anatomical adaptation. Research highlights: Aortic bulb expansion and recoil supported continuous blood flow in northern fur seals and Steller sea lions. Stroke volumes in these species matched predictions based on body size, suggesting that having a large aortic bulb does not necessitate having a greater stroke volume to support diving. [ABSTRACT FROM AUTHOR]

Background: Jails annually incarcerate millions of people with health problems, yet jail healthcare services have not been well described. Objective: To describe jail healthcare staffing. Design: Phone-administered survey conducted October 2020 to May 2021. Setting: County jails in North Carolina, South Carolina, Georgia, and Alabama. Participants: Jail personnel "most knowledgeable" about jail healthcare. Main Measures: Weekly on-site healthcare coverage rate (hours per 100 incarcerated person-weeks [IPWs]) by personnel type; telemedicine rates and detention officers' healthcare duties. Key Results: Survey response rate was 73% (254/346). Among surveyed jails, 71% had on-site non-psychiatric providers (e.g., physicians, physician assistants) (median of 3.3 h per 100 IPWs); 90% had on-site nursing (median of 57.0 h per 100 IPWs) including 50% with on-site registered nurses (median of 25 h per 100 IPWs) and 70% with on-site licensed practical nurses (median of 52 h per 100 IPWs); 9% had on-site psychiatric providers (median of 1.6 h per 100 PWs). Telemedicine was used for primary care in 13% of jails (median 2.1 h per 100 IPW); for mental healthcare in 55% (median 2.1 h per 100 IPW); and for other specialties in 5% (median 1.0 h per 100 IPW). In 81% of jails, officers conducted medical intake and in 58% assessed urgency of medical requests (i.e., "sick call"). The number of officers' healthcare responsibilities increased inversely with weekly nursing coverage. Conclusions: Nearly 30% of surveyed jails routinely lacked on-site healthcare providers and in most other jails providers' on-site presence was modest. Jails relied heavily on LPNs and officers for care, resulting in missed opportunities for care and potentially endangering incarcerated persons. [ABSTRACT FROM AUTHOR]

Introduction: We present a case of a patient with osteogenesis imperfecta (OI) and keratoglobus (KG) who had a near-total rupture of Descemet's membrane followed by spontaneous corneal clearing. This case is unique in that it demonstrates the potentially excellent outcome of conservative treatment for Descemet's rupture in patients with KG and illustrates the impressive migratory potential of healthy endothelial cells. Case Presentation: An 11-year-old girl with OI and KG who had rupture and near-total detachment of Descemet's membrane presented for evaluation. This was managed conservatively and resulted in the eventual spontaneous clearing of the cornea. A similar process happened in the fellow eye some years later. Given the result of conservative management originally, the patient was once again treated conservatively, with significant improvement in corneal edema and visual acuity. Conclusion: Given the size of the ruptures, this case highlights the dynamic nature of the corneal endothelium and provides an extreme example of the migratory potential of corneal endothelial cells. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae is increasingly resistant to antibiotics, and new therapies to prevent or treat K. pneumoniae infections are urgently needed. The mammalian adaptive immune response to K. pneumoniae infection has not been fully defined, but significant advances have been made in the past 5 years. T cells are instrumental in lung immunity to K. pneumoniae. Tissue-resident memory T cells (T RM cells), derived from type 17 T helper (Th17) cells and maintained by interleukin (IL)-7 signals, help to control repeat K. pneumoniae infection in the lung. Various monoclonal antibody (mAb) studies have demonstrated that some antibodies can protect against various K. pneumoniae infections. Many mAbs promote bacterial killing through opsonophagocytosis. Several exciting K. pneumoniae vaccine candidates or alternative therapies have shown promising results in animal models, but remain to be translated to humans. For many years the host adaptive immune response to K. pneumoniae was a relative black box. However, with the recent emergence of multidrug-resistant and hypervirulent strains of K. pneumoniae , this pathogen has been thrust into the research spotlight. Numerous laboratories are currently investigating host immune responses to K. pneumoniae with the ultimate goal of developing new prophylactics and therapeutics. Several promising vaccine candidates have been identified in preclinical studies that now require translation to human therapy. Klebsiella pneumoniae is among the most common antibiotic-resistant pathogens causing nosocomial infections. Additionally, it is a leading cause of neonatal sepsis and childhood mortality across the globe. Despite its clinical importance, we are only beginning to understand how the mammalian adaptive immune system responds to this pathogen. Further, many studies investigating potential K. pneumoniae vaccine candidates or alternative therapies have been launched in recent years. Here, we review the current state of knowledge on the adaptive immune response to K. pneumoniae infections and progress towards developing vaccines and other therapies to combat these infections. [ABSTRACT FROM AUTHOR]

Susan Sontag, in her classic 1967 essay, "The Pornographic Imagination," argued: "Tamed as it may be, sexuality remains one of the demonic forces in human consciousness .... "In the last half-century, Sontag's demonic force of sexuality has transformed pornography and the "pornographic imagination"—let along social relations between women and men. In this essay, I adopt Walter Benjamin's concept of phantasmagoria—a magic-lantern show of optical illusions, rapidly changing size and blending into one another—as the metaphoric commodity form of postmodern capitalist society, fetishism-on-display. I examine the evolution of technological forms of pornographic representation over the last two centuries, including the magiclantern, daguerreotype, photography, stereoscope and film as well as the internet, erotic toys, electronic devises, VR and sex robots. These developments are set against a background of equally profound legal and cultural developments that have recast the sexuality of postmodern America. I argue that these (and other) developments have recast patriarchy and, in some important ways, the sexual relations between "consenting" adults. I conclude reflecting on the current intellectual and political debate about pornography between "pro-sex" and "anti-sex" feminists. With the enormous increase in the production and availability of pornography, I ask, perhaps "quantity" can give way to improved "quality"? I ask whether today's sexual phantasmagoria can fashion a "new" feminist sexuality—and a more humane pornography? [ABSTRACT FROM AUTHOR]

Using a creative production task, jazz improvisation, we tested alternative hypotheses about the flow experience: (A) that it is a state of domain-specific processing optimized by experience and characterized by minimal interference from task-negative default-mode network (DMN) activity versus (B) that it recruits domain-general task-positive DMN activity supervised by the fronto-parietal control network (FPCN) to support ideation. We recorded jazz guitarists' electroencephalograms (EEGs) while they improvised to provided chord sequences. Their flow-states were measured with the Core Flow State Scale. Flow-related neural sources were reconstructed using SPM12. Over all musicians, high-flow (relative to low-flow) improvisations were associated with transient hypofrontality. High-experience musicians' high-flow improvisations showed reduced activity in posterior DMN nodes. Low-experience musicians showed no flow-related DMN or FPCN modulation. High-experience musicians also showed modality-specific left-hemisphere flow-related activity while low-experience musicians showed modality-specific right-hemisphere flow-related deactivations. These results are consistent with the idea that creative flow represents optimized domain-specific processing enabled by extensive practice paired with reduced cognitive control. • The flow state has been described as effortless attention to a task. • Few studies have examined the neural basis of flow during creative production. • We examined flow-related neural activity by recording EEGs during jazz improvisation. • High-flow versus low-flow is associated with greater left-hemisphere activity and reduced frontal and default-mode activity. • The results support the view that creative flow is a state of optimized, domain-specific processing. [ABSTRACT FROM AUTHOR]

In this study, we propose a mechanical analysis for estimating the internal pressure of a finitely deformed spherical compartment from Lamb wave measurements. The proposed analysis produces a dispersion relation associating Lamb wave speed with pressure using limited material parameters (only a strain stiffening term). The analysis was validated on ultrasound bladder vibrometry (UBV) experiments collected from 9 ex vivo porcine bladders before and after formalin cross-linking. Estimated pressures were compared with pressures measured directly by a pressure transducer. The proposed analysis proved broadly effective at estimating pressure from UBV based Lamb wave without calibration as demonstrated by the observed concordance between estimated and measured pressures (Lin’s CCC = 0.82 (0.66-0.91). Theoretical limitations and potential refinements to improve the accuracy and generality of the approach are discussed. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to estimate the prevalence of individuals receiving hormone therapy for menopause management and the prevalence of underlying conditions that may constrain options for pharmacologic menopause management in the prison context. Design/methodology/approach: This study reviewed all prescriptions dispensed by the North Carolina Department of Public Safety between July 1, 2015, and June 30, 2016, for relevance to menopause management. Relevant medications were those either recommended for menopause management or those indicated for management of conditions that may complicate menopause management, as per the 2015 clinical decision-support algorithm tool developed by the North American Menopause Society. Analysis was restricted to women between the ages of 45 and 75. Findings: Of 1,120 women, a majority (77.8%) were between the ages of 45 and 54. Less than 5% of individuals in this study were prescribed estrogen-containing therapy. The most commonly prescribed medications that may constrain options for menopause treatment were related to hypertension and other cardiovascular disease or mental health conditions. Research limitations/implications: The retrospective nature of this data set limits the findings, given that researchers did not have access to diagnoses or data on polypharmacy. Still, this study indicates that many women over 45 experiencing incarceration are living with health conditions that may complicate menopause symptom management with hormone therapy. Future research in carceral settings must examine the prevalence of menopause-related symptoms as well as access to and quality of comprehensive menopause management. Originality/value: There is a paucity of literature around the menopause-related needs of individuals experiencing incarceration. To the best of the authors' knowledge, no other research has examined prevalence of pharmacologic menopause management among women who are incarcerated. [ABSTRACT FROM AUTHOR]

Quantifying the energy needs of individual animals and understanding the relationship between food intake and physical growth are necessary to determine species-level food requirements and to model potential responses to changing environmental conditions. To provide fine-scale information about developmental and seasonal patterns in the energetic requirements of Arctic phocid seals, we documented longitudinal changes in food intake, body mass, and standard length in four spotted seals (Phoca largha), three ringed seals (Pusa hispida), and two bearded seals (Erignathus barbatus). The seals were studied for up to 9 years in subarctic and/or temperate climates while living under human care. Seals were fed using behavioral criteria that allowed their food intake and body mass to vary naturally. Gross energy intake (GEI) increased with age in all species, reaching a plateau as seals matured. GEI was greatest for the largest species (bearded seals) and lowest for the smallest (ringed seals). Massspecific GEI declined with age and was similar between spotted and ringed seals, with bearded seals consuming about half as much as the smaller species. Overlaid upon long-term developmental changes were predictable seasonal cycles in food intake and body mass which became more pronounced as seals matured. Seasonal cycles in food intake and body mass did not always reflect simple cause-and-effect relationships. For example, seasonal peaks in food intake were regularly associated with simultaneous declines in body mass. The consistency of energy intake patterns, despite seals being maintained in semi-artificial conditions in different local climates, supports the hypothesis that seasonal oscillations are guided by underlying hormonal changes linked to key life history events and mediated by the physical environment. The described physiological patterns serve to highlight times of year when free-ranging Arctic seals may be more sensitive to environmental perturbations. [ABSTRACT FROM AUTHOR]

Objective. Detrusor overactivity (DO) is a urodynamic observation characterized by fluctuations in detrusor pressure (P det) of the bladder. Although detecting DO is important for the management of bladder symptoms, the invasive nature of urodynamic studies (UDS) makes it a source of discomfort and morbidity for patients. Ultrasound bladder vibrometry (UBV) could provide a direct and noninvasive means of detecting DO, due to its sensitivity to changes in elasticity and load in the bladder wall. In this study, we investigated the feasibility and applying UBV toward detecting DO. Approach. UBV and urodynamic study (UDS) measurements were collected in 76 neurogenic bladder patients (23 with DO). Timestamped group velocity squared ( c g 2 ) data series were collected from UBV measurements. Concurrent P det data series were identically analyzed for comparison and validation. A processing approach is developed to separate transient fluctuations in the data series from the larger trend of the data and a DO index is proposed for characterizing the transient peaks observed in the data. Main Results. Applying the DO index as a classifier for DO produced sensitivities and specificities of 0.70 and 0.75 for c g 2 data series and 0.70 and 0.83 for P det data series respectively. Significance. It was found that DO can be feasibly detected from data series of timestamped UBV measurements. Collectively, these initial results are promising, and further refinement to the UBV measurement process is likely to improve and clarify its capabilities for noninvasive detection of DO. [ABSTRACT FROM AUTHOR]

Background: Hysterectomy is the most commonly performed benign gynaecological surgery. Recently, the rates of minimally invasive hysterectomy have fallen due to the banning of mechanical morcellation techniques that rendered minimal invasive gynaecology surgeons unable to extract large uteri from the relatively small colpotomy incisions. Aims: This study aims to share our experience in utilising Colpo‐V incision to remove large uterine specimens transvaginally and report its success and complication rates to promote a minimal invasive approach in patients with large uteri without the need to perform large abdominal incisions or transabdominal morcellation. Methods: This is a prospective case series study in which women with large uteri and|or narrow vaginal canal underwent total laparoscopic hysterectomy and a subsequent posterior vaginal wall incision (Colpo‐V) to facilitate the intact extraction of the uterus through the vagina. Patients were seen in the clinic six weeks after the surgery for post‐operative assessment and documentation of late complications. Results: Seventeen women underwent the procedure, and the intact extraction of the specimen was successful in 16 out of the 17 cases (94%). No major complications were encountered during or after the procedure. Conclusion: Colpo‐V incision is a simple and effective technique for the intact extraction of larger uterine specimens at hysterectomy. [ABSTRACT FROM AUTHOR]

Theories of the processes involved in creative cognition posit that cognitive control has a negative effect on creative idea generation but a positive effect on creative idea evaluation. Brain stimulation research has started to examine empirically the effects of cognitive control, with several reports of decreased cognitive control facilitating creative ideation. Such studies have shown how decreased cognitive control mechanisms facilitate creative idea generation, potentially by allowing participants access to less inhibited weaker-related associations, thereby increasing novelty. In the current study, we advance this line of work by investigating how cognitive control affects creative thinking, potentially inhibiting or facilitating novel idea generation based on task demands. Participants read sentences with the final word missing and were instructed to complete the sentence with an uncommon (but appropriate) ending. Participants performed this task while undergoing either anodal (excitatory), cathodal (inhibitory), or sham (control) transcranial direct current stimulation over their left prefrontal cortex. These responses were then rated for their novelty and appropriateness by an independent sample of raters. We found that anodal stimulation increased the appropriateness and decreased the novelty of participants' responses. Contrary to previous studies, we did not find that cathodal stimulation increased the novelty of participants' responses, which may be due to the nature of our task. Overall, we demonstrate how cognitive control mechanisms may inhibit novel idea generation. [ABSTRACT FROM AUTHOR]

Background: Prediction of cardiac surgery-associated acute kidney injury (CS-AKI) in pediatric patients is crucial to improve outcomes and guide clinical decision-making. This study aimed to develop a supervised machine learning (ML) model for predicting moderate to severe CS-AKI at postoperative day 2 (POD2). Methods: This retrospective cohort study analyzed data from 402 pediatric patients who underwent cardiac surgery at a university-affiliated children's hospital, who were separated into an 80%-20% train-test split. The ML model utilized demographic, preoperative, intraoperative, and POD0 clinical and laboratory data to predict moderate to severe AKI categorized by Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 or 3 at POD2. Input feature importance was assessed by SHapley Additive exPlanations (SHAP) values. Model performance was evaluated using accuracy, area under the receiver operating curve (AUROC), precision, recall, area under the precision-recall curve (AUPRC), F1-score, and Brier score. Results: Overall, 13.7% of children in the test set experienced moderate to severe AKI. The ML model achieved promising performance, with accuracy of 0.91 (95% CI: 0.82–1.00), AUROC of 0.88 (95% CI: 0.72–1.00), precision of 0.92 (95% CI: 0.70–1.00), recall of 0.63 (95% CI: 0.32–0.96), AUPRC of 0.81 (95% CI: 0.61–1.00), F1-score of 0.73 (95% CI: 0.46–0.99), and Brier score loss of 0.09 (95% CI: 0.00–0.17). The top ten most important features assessed by SHAP analyses in this model were preoperative serum creatinine, surgery duration, POD0 serum pH, POD0 lactate, cardiopulmonary bypass duration, POD0 vasoactive inotropic score, sex, POD0 hematocrit, preoperative weight, and POD0 serum creatinine. Conclusions: A supervised ML model utilizing demographic, preoperative, intraoperative, and immediate postoperative clinical and laboratory data showed promising performance in predicting moderate to severe CS-AKI at POD2 in pediatric patients. [ABSTRACT FROM AUTHOR]

Over the last few years, there is an apparent growing concern amongst O&G trainees of the inadequacy in exposure to minimally invasive gynaecology surgical training, which has been inadvertently compounded by the more stringent working hour regulations and disproportionately increasing number of trainees relative to surgical volume. Therefore, it is vitally important for trainees to maximise opportunities in the operating theatre and develop autonomy in carrying out more complex surgical procedures. This case report outlines the step-by-step approach of laparoscopic excision of a cornual ectopic pregnancy performed by a trainee under the supervision of a surgical mentor. This manuscript highlights key characteristic traits of a trainee that serve to foster surgical trust and simple but effective steps to foster surgical preparedness. [ABSTRACT FROM AUTHOR]

Law enforcement officers frequently encounter people with health conditions. We sought to estimate the rates, diagnoses, and characteristics of emergency department (ED) visits among patients transported directly by law enforcement. We analyzed statewide North Carolina Emergency Department data for adults, aged 18+ years, from 2009 to 2016. We estimated transport rates using census data; categorized primary ED diagnoses into 13 major and 8 substituent categories; compared county transport rates by rurality; and examined patient characteristics. There were 136,240 patients transported by law enforcement; annual rates increased from 186.9 (per 100,000 adult residents) in 2009 to 279.2 in 2016. Among visits, 67.7% were among men, the median age was 37 years, and 20.4% resulted in a hospital admission. Most common primary diagnoses were Mental Health Diagnoses (43.1%)—including Schizophrenia and other Psychotic Disorders (7.6%), Mood Disorders (9.7%), and Alcohol and Substance Use (10.7%)—followed by Injury and Poisoning (12.4%) and Circulatory conditions (4.1%). Involuntary commitments constituted 22% of all visits. The median transport rate in rural counties, 291.1, was 2 times that of large metro counties, 145.1. The visit rate increased by nearly 50% during the study period, with the highest rates in rural counties. Many transports were for Mental Illness and involuntary commitments. The relatively common occurrence of law enforcement transports suggests the need for greater research to understand factors influencing law enforcement transport decisions, the impact of these transports on patient health and safety, and the repercussions on patient care of a growing officer presence in EDs. [ABSTRACT FROM AUTHOR]

Pinnipeds have specific macronutrient (protein, lipid) requirements to satisfy physiological functions, yet little is known about how diet characteristics affect macronutrient digestibility. We measured relative and absolute lipid and protein digestibility in six female northern fur seals (Callorhinus ursinus (Linnaeus, 1758)) fed eight experimental diets composed variously of four prey species (Pacific herring, Clupea pallasii Valenciennes in Cuvier and Valenciennes, 1847; walleye pollock, Gadus chalcogrammus Pallas, 1814 (formerly Theragra chalcogramma (Pallas, 1814)); capelin, Mallotus villosus (Müller, 1776); magister armhook squid, Berryteuthis magister (Berry, 1913)). We quantified how digestibility was affected by proximate composition of the diet (% lipid or % protein), levels of food mass and macronutrient intake, and tested for any potential benefit of multi-species diets. Overall, digestibility of both protein and lipid were high across diets, although macronutrient retention of lipids (96.0%–98.4%) was significantly higher than protein (95.7%–96.7%) for all but the two highest protein diets. Increased levels of protein intake resulted in increased protein retention, but decreased lipid digestibility. There was no evidence that mixed-species diets provide greater macronutrient digestibility over single-species diets. The results suggest that high to moderate lipid diets are more beneficial to northern fur seals because they lead to increased levels of lipid retention without large decreases in protein digestibility. This raises concerns that dietary factors may be contributing to the population declines of northern fur seals in the Bering Sea. [ABSTRACT FROM AUTHOR]

The opening of the Suez Canal in 1869 created a tremendous impact both on the shipping industry, by shortening navigational routes, and on ecological communities in the Mediterranean Sea, by facilitating numerous introductions of non-indigenous species (NIS). These impacts are deeply intertwined as the majority of Mediterranean Sea introductions are ship-facilitated. Here we analyzed shipping data for the Canal between 2011-2018, and characterized the shipping trends of the Canal in relation to global shipping trends and to the introduction of NIS. We differentiated the data analysis between ballast-weighted ships and cargo laden ships according to nine ship categories: Tankers, LNG (Liquid Natural Gas) Ships, Bulk Carriers, General Cargo, Container Ships, Ro/Ro (Roll on/ off) ships, Car-Carriers, Passenger Ships, and Others. We used statistical tests to determine whether the August 2015 expansion influenced shipping trends and discuss our findings with respect to patterns in species introductions. Our findings show that although there has been an increase in tonnage being shipped through the Canal, this is a consequence of an increase in ship dimensions, while the actual number of ships for some categories has decreased. This pattern was particularly evident in the container ship category, which had the highest global growth compared to other ship categories. A few categories, such as bulk carriers and tankers, had more traffic in particular directions of passage. Only passenger ships and bulk carriers revealed significant seasonal transit trends, with higher transfers during spring and autumn for passenger ships and summer/autumn for bulk carriers. An increase in average ship size was evident for almost all categories. Larger ships imply a longer turnover time spent in ports and a larger available wetted surface area that is susceptible to fouling, thus potentially providing a larger fouling community with more time to propagate and settle in a novel habitat. Our findings emphasize the importance of identifying current shipping trends that may pose a threat to the Mediterranean Sea biodiversity in order to construct a follow-on policy to mitigate the transfer and delivery of NIS via the Suez Canal. Specifically, enforcement of antifouling regulations is highlighted as a significant contribution to the European Union Marine Strategy Framework Directive goals to achieve a good environmental status. [ABSTRACT FROM AUTHOR]

In the last few decades, something has changed about how Americans conceive of privacy, which has had consequences for how writers address their publics: how writers write. This essay argues that rapidly evolving and expanding surveillance regimes have profoundly affected our sense of where the private life begins and ends and what can or cannot be concealed from others. Discourses characterized by fragmentation, opacity, and indirection have become both a means by which we communicate information about ourselves to the larger world and a mimetic representation of how that surveillance-mediated world often appears to us. Literature has played a crucial role in these transformations and has served as a laboratory for many of these emerging discourses. This essay focuses on two recent and contrasting cohorts of American writers: a slightly older group of authors who saw the sacrifice of individual privacy as having catastrophic implications for liberal democracy, and a younger group whose views of privacy and communication were, on the whole, less panicked and more tactical. The essay concludes by considering what happens when rhetorical modes meant primarily to preserve the private self reenter the public sphere and assert themselves within a civil-minded conversation. [ABSTRACT FROM AUTHOR]

Bothriochloa glabra (Roxb.) A. Camus is reported for Texas. A key is provided to separate B. glabra from B. bladhii (Retz.) S.T. Blake. [ABSTRACT FROM AUTHOR]

This is the first record of Eleocharis mutata in Florida, and the second record in the continental USA, suggesting a potential natural range expansion of this species from the Caribbean region. A key to species of Eleocharis subg. Limnochloa in Florida is included, along with a site description of the occurrence, visual aids for identification, and a brief discussion of nativity. [ABSTRACT FROM AUTHOR]

This paper addresses the issue of minimizing support material in additive manufacturing (AM) during topology optimization (TO) in order to reduce material and post-processing costs. The TO method developed in this paper utilizes the moving morphable components (MMC) approach, where a structure is composed of several building blocks. This work introduces minimum build angle constraints to eliminate overhanging edges, supplementing these with penalty functions to ensure connectivity between building blocks, such that the TO output is printable. The MMC approach uses explicit geometric entities for the morphable components that are controlled by geometric parameters, such as length, thickness, and angle. These parameters are the design variables. Using this approach enables the formulation of geometric manufacturing constraints and the construction of CAD models, which are important advantages of the MMC method. Examples of a short cantilever beam and an MBB beam demonstrate the capabilities of the TO methods. [ABSTRACT FROM AUTHOR]

Purpose: Health and mortality of people released from incarceration have received increased attention, and yet little is known about the postrelease experiences of those hospitalized during incarceration.Methods: For persons incarcerated and released from the North Carolina (NC) state prison system between January 1, 2008, and June 30, 2015, we examined postrelease mortality from 2008 to 2016 by history of prison hospitalization.Results: Among 111,479 released persons, 0.9% (n = 1010) were hospitalized during their incarceration, and of those, 10.5% (n = 106) died during follow-up compared with 3.2% (3511/110,469) of other released persons. Those hospitalized in prison had a higher postrelease death rate (adjusted hazard ratio: 2.44), a lower 8-year conditional probability of survival (0.80 vs. 0.94), and were more likely to die from chronic causes (79.2% vs. 51.0%) than other released persons. The postrelease standardized mortality rate among men hospitalized in prison was 3.1 times higher than that of those not hospitalized and 7.1 times the rate of all NC men.Conclusions: People hospitalized during incarceration constitute a particularly vulnerable, yet relatively easily identifiable priority population to focus health interventions supporting continuity of care after prison release. Yet such efforts may be particularly challenging in NC and other Medicaid non-expansion states. [ABSTRACT FROM AUTHOR]

Strain elastography (SE) is a technique in which images of localized tissue strains are used to detect the relative stiffness of tissues. The application of SE in differentiating malignant breast lesions from benign ones has been broadly investigated. The strain ratio (SR) between the background and the breast tumor has been used and its results have been mixed. Due to the complex nature of tissue elasticity and how it relates to the strain fields measured in SE, the exact reason is not known. In this study, we apply a novel design-of-experiments-based metamodeling approach to mechanical simulation of SE in the human breast. To our knowledge, such a study has not been reported in the ultrasound SE literature. More specifically, we first conduct a screening study to identify the biomechanical factors/simulation inputs that most strongly determine SR. We then apply a response surface experimental design to these factors to produce a metamodel of SR as a function of said factors. Results from the screening study suggest that the SR measurements are primarily influenced by three factors: the initial shear modulus of the lesion, the elastic nonlinearity of the lesion, and the precompression applied during acquisition. In order to investigate the implications of these results, stochastic inputs for these three factors associated with the malignant and benign cases were applied to the resulting response surface. The resulting optimal cutoffs, sensitivity, and specificity were generally in line with a majority (>60%) of 19 clinical trials in the literature. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a relatively common chronic inflammatory disease with immune dysregulation. While eye manifestations of HS are rare, a dilemma arises when these patients seek treatment for refractive errors. Although excimer laser surgery can be safely performed in patients with autoimmune and immune-mediated inflammatory disease, there are caveats. Aside from the routine laser-assisted in situ keratomileusis (LASIK) screening tests, in some instances, we recommend additional screening tests in patients with HS, such as dry eye tests, consultation with specialists regarding HS diagnosis and treatment, careful assessment of the eyelids and periorbital structures, and thorough history of past and current lesions and treatments. After these patients undergo LASIK, careful, frequent, and long-term follow-up is necessary. Any adverse event or complication should be managed immediately. Funding: Research to Prevent Blindness funded the study. Hoopes Vision funded the Rapid Service Fees. [ABSTRACT FROM AUTHOR]

Changes in keratometric values and refraction can occur during pregnancy. For this reason, changing a patient's refractive prescription or undergoing corneal refractive surgery is not recommended during pregnancy. However, the extent to which these corneal changes persist during lactation is not as well reported. Pregnancy and lactation lead to hormonal changes that affect the corneal structure. LASIK, or other types of refractive surgery, is not recommended until all of the following conditions are met: cessation of lactation, the return of regular menses, and a return to pre-pregnancy refraction. Additionally, patients should be cautioned that refractive regression may occur if they become pregnant within 1 year of LASIK. Funding: Research to Prevent Blindness, NY, USA. [ABSTRACT FROM AUTHOR]

We aimed to compare rates and characteristics of suicide mortality in formerly incarcerated people with those of the general population in North Carolina. We conducted a retrospective cohort study of 266,400 people released from North Carolina state prisons between January 1, 2000, and March 1, 2020. Using direct and indirect standardization by age, sex, and calendar year, we calculated standardized suicide mortality rates and standardized mortality ratios comparing formerly incarcerated people with the North Carolina general population. We evaluated effect modification by race/ethnicity, sex, age, and firearm involvement. Formerly incarcerated people had approximately twice the overall suicide mortality of the general population for 3 years after release, with the highest rate of suicide mortality being observed in the 2-week period after release. In contrast to patterns in the general population, formerly incarcerated people had higher rates of non–firearm-involved suicide mortality than firearm-involved suicide mortality. Formerly incarcerated female, White and Hispanic/Latino, and emerging adult people had a greater elevation of suicide mortality than their general-population peers compared with other groups. These findings suggest a need for long-term support for formerly incarcerated people as they return to community living and a need to identify opportunities for interventions that reduce the harms of incarceration for especially vulnerable groups. This article is part of a Special Collection on Mental Health. [ABSTRACT FROM AUTHOR]

Jailed individuals have considerable healthcare needs, yet jail healthcare resources are often limited. We interviewed staff from 34 Southeastern jails about strategies that jails use to deliver healthcare. One of the most prominent strategies was the use of detention officers to provide or facilitate the provision of healthcare. Officers' roles included assessing the need for medical clearance, conducting medical intake screenings, monitoring for suicide/withdrawal, transporting patients to medical appointments, medication administration, monitoring blood glucose and blood pressure, responding to medical emergencies, and communication with healthcare personnel. Several participants reported that due to officer shortages, conflicting priorities, and lack of adequate training, officers' healthcare roles can compromise privacy, delay access to care, and result in inadequate monitoring and safety. Findings suggest the need for training and standardized guidelines for officers' involvement in jail healthcare delivery and reassessment of the scope of officers' healthcare responsibilities. • Jails are legally obligated to provide healthcare for "serious medical needs". • Detention officers often have medical duties, serve as medical gatekeepers. • Duties: health questionnaires, "med pass", recording signs/symptoms, among others. • Officers' healthcare and custodial roles can create competing priorities. • Officers' care activities likely conflict with nursing association guidance. [ABSTRACT FROM AUTHOR]

Abstract The extension of fused deposition modeling (FDM) to work with semicrystalline polymers is challenging due to crystallization that occurs during cooling. Conventional characterization methods such as differential scanning calorimetry (DSC) have been used to characterize this behavior; however, the heating and cooling rates available with DSC are much slower than rates experienced during FDM. The recently developed fast scanning calorimetry (FSC) can reach rates of 1000s of °C/s. Therefore, the objectives of this research are to evaluate FSC for replicating FDM conditions and to more fully understand the as-processed structure of semicrystalline polymers according to a three-phase model including a mobile amorphous fraction (MAF), a rigid amorphous fraction (RAF), and a crystalline fraction. A case study performed with polyphenylene sulfide showed that cooling rates experienced during FDM could hinder crystallization, while repeated reheating of material at relatively low crystallization temperatures during fabrication could increase the part crystallinity and RAF. Graphical abstract Image 1093 Highlights • FSC examined the effects of fast cooling rates on crystallization in FDM materials. • The cooling rates in FDM are fast enough to prevent crystallization in PPS. • Cyclic heating during additive FDM fabrication can increase crystallinity. • PPS was examined using a three-phase model. • A rigid amorphous fraction dependent on thermal exposure was observed in PPS. [ABSTRACT FROM AUTHOR]

Many important geometric estimation problems naturally take the form of synchronization over the special Euclidean group: estimate the values of a set of unknown group elements x 1 , ... , x n ∈ SE ( d ) given noisy measurements of a subset of their pairwise relative transforms x i − 1 x j . Examples of this class include the foundational problems of pose-graph simultaneous localization and mapping (SLAM) (in robotics), camera motion estimation (in computer vision), and sensor network localization (in distributed sensing), among others. This inference problem is typically formulated as a non-convex maximum-likelihood estimation that is computationally hard to solve in general. Nevertheless, in this paper we present an algorithm that is able to efficiently recover certifiably globally optimal solutions of the special Euclidean synchronization problem in a non-adversarial noise regime. The crux of our approach is the development of a semidefinite relaxation of the maximum-likelihood estimation (MLE) whose minimizer provides an exact maximum-likelihood estimate so long as the magnitude of the noise corrupting the available measurements falls below a certain critical threshold; furthermore, whenever exactness obtains, it is possible to verify this fact a posteriori, thereby certifying the optimality of the recovered estimate. We develop a specialized optimization scheme for solving large-scale instances of this semidefinite relaxation by exploiting its low-rank, geometric, and graph-theoretic structure to reduce it to an equivalent optimization problem defined on a low-dimensional Riemannian manifold, and then design a Riemannian truncated-Newton trust-region method to solve this reduction efficiently. Finally, we combine this fast optimization approach with a simple rounding procedure to produce our algorithm, SE-Sync. Experimental evaluation on a variety of simulated and real-world pose-graph SLAM datasets shows that SE-Sync is capable of recovering certifiably globally optimal solutions when the available measurements are corrupted by noise up to an order of magnitude greater than that typically encountered in robotics and computer vision applications, and does so significantly faster than the Gauss–Newton-based approach that forms the basis of current state-of-the-art techniques. [ABSTRACT FROM AUTHOR]

Many engineering applications utilize periodic lattice structures to take advantage of their favorable and tailorable mechanical properties. However, manufacturing the structures and evaluating their mechanical properties are still challenging. Additive manufacturing (AM) processes offer an alternative method to fabricate periodic lattice structures but the processes only approximate bounding part surfaces. Periodic lattice structures generally have two important geometrical characteristics, large bounding surfaces, and a large number of joints. Since geometric approximation errors on large bounding surfaces critically affect mechanical properties of the structures, designers and engineers should incorporate this degradation into mechanical property estimation procedures. In addition, the effects of joints should be analyzed in the estimation process, because joints reduce struts lengths, and as a result, they add stiffness to lattice structures. This paper presents a new homogenization approach to estimate mechanical properties of additively manufactured periodic lattice structures that is based on semirigid joint frame elements, and it takes into account effects of geometric approximation errors and joint stiffening. Effective structural parameters of a semirigid joint frame element are calculated from an as-fabricated voxel model to incorporate the geometric approximation errors. The semirigid joint frame element is integrated into a discrete homogenization process to evaluate joint stiffening effects. This paper reports results of parametric studies that investigate effects of AM process and joint properties on periodic lattice structures fabricated by material extrusion. This paper also compares estimates from the proposed approach and conventional homogenization approaches with test results. The comparison shows that the proposed method provides estimates that are more accurate. [ABSTRACT FROM AUTHOR]

The advent of container vessel networks has revolutionized global freight transport. While numerous studies in various disciplines such as economics, law, geography, engineering, and more, have discussed the impact of the "Container Revolution", we would like to share our insights here regarding the impact of container shipping networks on current and potential future trends in marine bioinvasion. We discuss the shift in centers and routes of high shipping intensity, and the importance of "Hub" versus "Feeder" ports, in relation to potential invasion routes. The increasing use of Ultra-Large Container Vessels (ULCV) worldwide is leading to further change in introduction dynamics: fewer vessels are now required for the transshipment of goods, as evident from our analysis of vessel movement via the Suez Canal. An investigation of adapted maintenance regulations is thus required in order to prevent the spread of alien species as fouling communities on particular niche areas of ULCVs. ULCVs further advance the hub-and-spoke network. Hub ports are characterized by the close physical proximity of large vessels (intercontinental mainliners) to many smaller vessels (feeders), calling in at local ports, as well as to other large vessels. This vessel interface occurs on a regular repetitive weekly cycle within a relatively small maritime environment. Thus a systematic network of potential vectors of bio-invasion is being established on both regional and continental levels. The increasing development of large container ports globally, and of larger vessels, demands a thorough investigation of their effect on bioinvasion potential. An integrated study of both the commercial and the biological networks is thus essential in order to fully comprehend their interaction. [ABSTRACT FROM AUTHOR]

Prison inmates suffer from a heavy burden of physical and mental health problems and have considerable need for healthcare and coverage after prison release. The Affordable Care Act may have increased Medicaid access for some of those who need coverage in Medicaid expansion states, but inmates in non-expansion states still have high need for Medicaid coverage and face unique barriers to enrollment. We sought to explore barriers and facilitators to Medicaid enrollment among prison inmates in a non-expansion state. We conducted qualitative interviews with 20 recently hospitalized male prison inmates who had been approached by a prison social worker due to probable Medicaid eligibility, as determined by the inmates' financial status, health, and past Medicaid enrollment. Interviews were transcribed verbatim and analyzed using a codebook with both thematic and interpretive codes. Coded interview text was then analyzed to identify predisposing, enabling, and need factors related to participants' Medicaid enrollment prior to prison and intentions to enroll after release. Study participants' median age, years incarcerated at the time of the interview, and projected remaining sentence length were 50, 4, and 2 years, respectively. Participants were categorized into three sub-groups based on their self-reported experience with Medicaid: (1) those who never applied for Medicaid before prison (n = 6); (2) those who unsuccessfully attempted to enroll in Medicaid before prison (n = 3); and (3) those who enrolled in Medicaid before prison (n = 11). The six participants who had never applied to Medicaid before their incarceration did not hold strong attitudes about Medicaid and mostly had little need for Medicaid due to being generally healthy or having coverage available from other sources such as the Veteran's Administration. However, one inmate who had never applied for Medicaid struggled considerably to access mental healthcare due to lapses in employer-based health coverage and attributed his incarceration to this unmet need for treatment. Three inmates with high medical need had their Medicaid applications rejected at least once pre-incarceration, resulting in periods without health coverage that led to worsening health and financial hardship for two of them. Eleven inmates with high medical need enrolled in Medicaid without difficulty prior to their incarceration, largely due to enabling factors in the form of assistance with the application by their local Department of Social Services or Social Security Administration, their mothers, medical providers, or prison personnel during a prior incarceration. Nearly all inmates acknowledged that they would need health coverage after release from prison, and more than half reported that they would need to enroll in Medicaid to gain healthcare coverage following their release. Although more population-based assessments are necessary, our findings suggest that greater assistance with Medicaid enrollment may be a key factor so that people in the criminal justice system who qualify for Medicaid-and other social safety net programs-may gain their rightful access to these benefits. Such access may benefit not only the individuals themselves but also the communities to which they return. [ABSTRACT FROM AUTHOR]

Generative design (GD) techniques have been proposed to generate numerous designs at early design stages for ideation and exploration purposes. Previous research on GD using deep neural networks required tedious iterations between the neural network and design optimization, as well as post-processing to generate functional designs. Additionally, design constraints such as volume fraction could not be enforced. In this paper, a two-stage non-iterative formulation is proposed to overcome these limitations. In the first stage, a conditional generative adversarial network (cGAN) is utilized to control design parameters. In the second stage, topology optimization (TO) is embedded into cGAN (cGAN + TO) to ensure that desired functionality is achieved. Tests on different combinations of loss terms and different parameter settings within topology optimization demonstrated the diversity of generated designs. Further study showed that cGAN + TO can be extended to different load and boundary conditions by modifying these parameters in the second stage of training without having to retrain the first stage. Results demonstrate that GD can be realized efficiently and robustly by cGAN+TO. [ABSTRACT FROM AUTHOR]

Our primary objective of this work was to design and test a new time-of-flight (TOF) method that allows measurements of shear wave speed (SWS) following impulsive excitation in soft tissues. Particularly, under the assumption of the local plane shear wave, this work named the Fourier-domain shift matching (FDSM) method, estimates SWS by aligning a series of shear waveforms either temporally or spatially using a solution space deduced by characteristic curves of the well-known 1-D wave equation. The proposed SWS estimation method was tested using computer-simulated data, and tissue-mimicking phantom and ex vivo tissue experiments. Its performance was then compared with three other known TOF methods: lateral time-to-peak (TTP) method with robust random sampling consensus (RANSAC) fitting method, Radon sum transformation method, and a modified cross correlation method. Hereafter, these three TOF methods are referred to as the TTP-RANSAC, Radon sum, and X-corr methods, respectively. In addition to an adapted form of the 2-D Fourier transform (2-D FT)-based method in which the (group) SWS was approximated by averaging phase SWS values was considered for comparison. Based on data evaluated, we found that the overall performance of the above-mentioned temporal implementation of the proposed FDSM method was most similar to the established Radon sum method (correlation = 0.99, scale factor = 1.03, and mean difference = 0.07 m/s), and the 2-D FT (correlation = 0.98, scale factor = 1.00, and mean difference = 0.10 m/s) at high signal quality. However, results obtained from the 2-D FT method diverged (correlation = 0.201) from these of the proposed temporal implementation in the presence of diminished signal quality, whereas the agreement between the Radon sum approach and the proposed temporal implementation largely remained the same (correlation = 0.98). [ABSTRACT FROM AUTHOR]

In 2011, North Carolina (NC) created a program to facilitate Medicaid enrollment for state prisoners experiencing community inpatient hospitalization during their incarceration. The program, which has been described as a model for prison systems nationwide, has saved the NC prison system approximately $10 million annually in hospitalization costs and has potential to increase prisoners' access to Medicaid benefits as they return to their communities. This study aims to describe the history of NC's Prison-Based Medicaid Enrollment Assistance Program (PBMEAP), its structure and processes, and program personnel's perspectives on the challenges and facilitators of program implementation. We conducted semi-structured interviews and a focus group with PBMEAP personnel including two administrative leaders, two "Medicaid Facilitators," and ten social workers. Seven major findings emerged: 1) state legislation was required to bring the program into existence; 2) the legislation was prompted by projected cost savings; 3) program development required close collaboration between the prison system and state Medicaid office; 4) technology and data sharing played key roles in identifying inmates who previously qualified for Medicaid and would likely qualify if hospitalized; 5) a small number of new staff were sufficient to make the program scalable; 6) inmates generally cooperated in filling out Medicaid applications, and their cooperation was encouraged when social workers explained possible benefits of receiving Medicaid after release; and 7) the most prominent program challenges centered around interaction with county Departments of Social Services, which were responsible for processing applications. Our findings could be instructive to both Medicaid non-expansion and expansion states that have either implemented similar programs or are considering implementing prison Medicaid enrollment programs in the future. [ABSTRACT FROM AUTHOR]

Current creativity research reveals a fundamental disagreement about the nature of creative thought, specifically, whether it is primarily based on automatic, associative (Type 1) or executive, controlled (Type 2) cognitive processes. We propose that Type 1 and Type 2 processes make differential contributions to creative production depending on domain expertise and situational factors such as task instructions. We tested this hypothesis with jazz pianists who were instructed to improvise to a novel chord sequence and rhythm accompaniment. Afterward, they were asked to perform again under instructions to be especially creative which, via goal activation, is thought to prompt the musicians to engage Type 2 processes. Jazz experts rated all performances. Overall, performances by more experienced pianists were rated as superior. Moreover, creativity instructions resulted in higher ratings. However, there was an interaction between instructions and expertise, revealing that explicit creativity instructions significantly improved improvisation ratings only for the less experienced musicians. We propose that activating or reconfiguring executive Type 2 processes facilitates creativity for less experienced musicians, but does not improve creative performance significantly for more experienced ones because the latter have largely automatized the processes responsible for high-level improvisation or because they have achieved a near-optimal balance between associative Type 1 and executive Type 2 processes. Thus, increasing controlled Type 2 processing is unlikely to help, and may sometimes even diminish, the creativity of experts' performances. [ABSTRACT FROM AUTHOR]

This chapter discusses a range of issues that together paint a picture of the impact, potential, and challenges of using digital technologies in adult education. [ABSTRACT FROM AUTHOR]

Exposure Controlled Projection Lithography (ECPL) is a stereolithography-based additive manufacturing process, curing photopolymer parts on a stationary substrate. To improve the process accuracy with a closed-loop control, an in situ interferometric curing monitoring and measurement (ICM&M) system was developed to infer the output of cured height. The authors have previously reported an ICM&M method which consists of a sensor model for the ICM&M system and online parameter estimation algorithms based on instantaneous frequency. In this paper, to validate the ICM&M method, an application program was created in MATLAB to integrate the ECPL and ICM&M systems and to acquire and analyze interferograms online. Given the limited computing power, the ECPL process interferograms were acquired real time and analyzed off-line. A series of experiments was performed curing square samples by varying exposure time and intensity. Results show that the ICM&M can provide a cost-effective measurement for cured heights with excellent accuracy and reliability, and possess decent capability of estimating lateral dimensions. The off-line ICM&M is a convincing demonstration and benchmark for the real-time ICM&M metrology, providing a comprehensive evaluation of the ICM&M system's measurement characteristics as well as its utilities in modeling and control of the additive manufacturing process dynamics. [ABSTRACT FROM AUTHOR]

OBJECTIVE To establish normal values for pre- and post-prandial bile acids and protein C in Pacific harbor seal (Phoca vitulina richardsi) pups. ANIMALS 45 harbor seals undergoing rehabilitation at the Vancouver Aquarium Marine Mammal Rescue Centre, 0 to 16 weeks, and deemed healthy aside from malnutrition or maternal separation. PROCEDURES Venous blood was collected from the intervertebral extradural sinus in fasted seals and again 2 hours after a fish meal. RESULTS The reference interval (90% CL, confidence limit) for pre-prandial (fasting) bile acids was 17.2 µmol/L to 25.4 µmol/L, post-prandial bile acids were 36.9 µmol/L to 46.4 µmol/L, and protein C was 72.3% to 85.4%, across ages. For comparison between developmental ages, pups were grouped into 3 age classes: < 14 days, 5 to 8 weeks, and 10 to 16 weeks. Age affected pre- and post-prandial bile acids; pups < 14 days had significantly higher pre-prandial bile acids (36.0 µmol/L ± 16.5 µmol/L; P < .0001) than other age groups and pups 5 to 8 weeks had significantly higher post-prandial bile acids (50.4 µmol/L ± 21.9 µmol/L; P < .001). Protein C was also affected by age, with seals < 14 days having significantly lower values (mean, 51.8% ± 16.7%; P < .0001). CLINICAL RELEVANCE This study established normal reference intervals for bile acids in harbor seal pups and offered a preliminary investigation into protein C in pinnipeds. The bile acid values from 0- to 16-week-old seal pups were well above established normal ranges for domestic species, highlighting the utility of age- and species-specific reference ranges. The values presented here and the differences across age classes will aid clinicians in accurately diagnosing hepatobiliary disease in harbor seal pups. [ABSTRACT FROM AUTHOR]

Sea otters (Enhydra lutris) are known ecosystem engineers that have significant impacts on their kelp forest and rocky intertidal communities due to their high levels of food intake. Quantifying sea otter food biomass and energy intake is a valuable way to understand potential ecological impacts of sea otter populations on ecosystems and for predicting future population trends and potential for expansion. While detailed, fine-scale, age-specific food intake is difficult to quantify in wild sea otters, there is a wealth of potential information available from otters under human care. This study used food and energy intake data from husbandry records of 10 sea otters collected over three decades at the Vancouver Aquarium. Within these husbandry records, daily food biomass intake and body mass measurements were recorded and converted to annual average food mass and gross energy intake (GEI). Age-, sex-, and mass-specific trends were also observed. Young sea otters had the highest relative ingested food mass, equivalent to ~26% of body mass, which decreased to ~20% in adult otters. Young otters similarly had the highest mass-specific GEI, where measures from near birth to year 1 were ~40% higher than at year 3, the age of sexual and physical maturity. There were also key differences in trends between sexes. Captive adult male sea otters were 25 to 42% larger than females and their GEI was 23 to 58% higher, although mass-specific GEI was almost identical for male and non-reproductive female otters at all ages, plateauing at ~650 kJ kg-1 d-1. Despite high levels of ingested food mass, GEI was only 5 to 15% higher than for other captive marine mammals and was comparable to previous estimates for wild sea otters. These estimates of ingested food mass and energy intake requirements are valuable when modelling the ecological impact of sea otter populations and for considering the potential effects of future environmental changes. [ABSTRACT FROM AUTHOR]

Marine mammals are characterized as having physiological specializations that maximize the use of oxygen stores to prolong time spent under water. However, it has been difficult to undertake the requisite controlled studies to determine the physiological limitations and trade-offs that marine mammals face while diving in the wild under varying environmental and nutritional conditions. For the past decade, Steller sea lions ( Eumetopias jubatus) trained to swim and dive in the open ocean away from the physical confines of pools participated in studies that investigated the interactions between diving behaviour, energetic costs, physiological constraints, and prey availability. Many of these studies measured the cost of diving to understand how it varies with behaviour and environmental and physiological conditions. Collectively, these studies show that the type of diving (dive bouts or single dives), the level of underwater activity, the depth and duration of dives, and the nutritional status and physical condition of the animal affect the cost of diving and foraging. They show that dive depth, dive and surface duration, and the type of dive result in physiological adjustments (heart rate, gas exchange) that may be independent of energy expenditure. They also demonstrate that changes in prey abundance and nutritional status cause sea lions to alter the balance between time spent at the surface acquiring oxygen (and offloading CO and other metabolic by-products) and time spent at depth acquiring prey. These new insights into the physiological basis of diving behaviour further our understanding of the potential scope for behavioural responses of marine mammals to environmental changes, the energetic significance of these adjustments, and the consequences of approaching physiological limits. [ABSTRACT FROM AUTHOR]

With the design freedoms afforded by additive manufacturing (AM) processes, an increasing interest in shape synthesis methods has led to a variety of advances in topology optimisation methods and associated synthesis technologies. In this paper, we identify research issues related to the application of AM to shape synthesis methods, review recent advances in topology optimisation, and outline a vision for future synthesis capabilities. [ABSTRACT FROM PUBLISHER]

Background After surgical debridement, the use of fecal diversion systems (such as an endo-rectal tube or surgical colostomy) in Fournier's Gangrene (FG) to assist with wound healing remains controversial. Methods A 6-y retrospective review of a tertiary medical center emergency surgery database was conducted. Variables abstracted from the database include patient demographics, laboratory and physiological profiles, hospital length-of-stay, intensive care unit length-of-stay, operative data, time to healing, morbidity, and mortality. Results Thirty-five patients were treated. Seventy-seven percent ( n = 27) required some form of fecal diversion (21 patients using an endo-rectal tube and six patients undergoing construction of a surgical colostomy). One patient had a pre-existing colostomy before the development of FG. The remaining seven patients underwent conservative wound care with multiple daily dressing changes (no diversion system). Twenty-eight of the 35 patients (80.0%) had long-term follow-up with 100% having completely healed surgical wounds at the final clinic visit. Average time to complete wound healing was 4.8 ± 1.0 mo (range, 1.0-31.0). Of the six patients who underwent colostomy formation, two had their colostomies reversed, two were unacceptable surgical risk and did not undergo reversal (due to uncontrolled diabetes and cardiovascular disease), and two were lost to follow-up. Of the two patients who had their colostomies reversed both had complications from their reversal (leak and urinary retention). Conclusions Surgical colostomy may not be mandatory (and might be associated with a high additional morbidity) in FG. With appropriate patient selection, it may be possible to avoid colostomy formation using a less-invasive diversion technology without compromising patient outcomes. [ABSTRACT FROM AUTHOR]

Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA). We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative sample of prisoners to estimate the number eligible for healthcare coverage at release. There were 643,290 US male prisoners aged 18–64 with a chronic health condition. At release, 73% in Medicaid-expansion states would qualify for Medicaid or tax credits. In non-expansion states, 54% would qualify for tax credits, but 22% (n = 69,827) had incomes of ≤ 100% the federal poverty limit and thus would be ineligible for ACA-mediated healthcare coverage. These prisoners comprise 11% of all male prisoners with a chronic condition. The ACA was projected to provide coverage to most male state prisoners with a chronic health condition; however, roughly 70,000 fall in the “coverage gap” and may require non-routine care at emergency departments. Mechanisms are needed to secure coverage for this at risk group and address barriers to routine utilization of health services. [ABSTRACT FROM AUTHOR]

Purpose Exposure controlled projection lithography (ECPL) is an additive manufacturing process based on controlled UV photopolymerization. This paper aims to explore an advanced closed-loop control methodology to ECPL.Design/methodology/approach This paper proposes an evolutionary cycle to cycle (EC2C) control method, and started with a reduced order EC2C time control to control only the exposure time for given DMD bitmaps, which correspond to target 3D part cross-sections. A preliminary EC2C time control scheme was developed and followed by two types of EC2C time controllers based on two different parameter estimation methods, recursive least squares and L1 norm minimization (L1Min). Both algorithms were in an exponential weighted form, resulting in EWRLS and EWL1Min, to weight more on recent data to reflect the current process dynamics.Findings EWRLS was found to outperform EWL1Min in terms of computation speed and stability. The simulation study demonstrated that the proposed EC2C time control method was capable of adaptively tracking the ECPL process dynamics and updating online the model parameters with real-time measurements. It could control perfectly the exposure time for each bitmap, achieving the desired height for each layer and resulting in a total cured height conforming to the target 3D part height.Research limitations/implications The accuracy of EC2C time control method relies heavily on fast and accurate measurement, and this research assumes availability of an adequate real-time metrology. Measurement errors are not considered in this paper and will be explored in future. Only simulation study was performed without physical experiments to verify the EC2C controller.Practical implications For implementation, a real-time measurement system needs to be developed and the EC2C control software needs to be programmed and interfaced with the physical system.Originality/value It concludes that EC2C control method is very promising for a physical implementation, and could be extended for the development of a more comprehensive closed-loop controller for both exposure time and intensity to improve the ECPL process precision and robustness. [ABSTRACT FROM AUTHOR]