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In this project, a mobile, renewable, and versatile generation unit is designed. It utilizes solar and wind energy resources which make it usable in any location. The power source can effectively support emergency situations, such as hurricane, wildfire, earthquake, as well as special events such as remote training. It can provide at least 3.7kW to run multiple tools used during search and rescue situations. Specifically, the unit has seven 5-VDC 2-A DC/USB outlets, two AC 120-V 15-A outlets, and four 6-W LED lights which serve diverse equipment and devices. Its battery system could potentially run on its own for 12 hours when supplying 1kW. The unit is housed in a normally-sized trailer with the total weight of around 10,000 lbs. It is very versatile as it can be towed by any popular truck to diverse locations. Simulation has shown that the unit works properly and all design expectations have been met. The use of this green power source will help save lives while keeping our air clean

Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5–10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.

A multidisciplinary team at a tertiary care Veterans Health Administration medical center created a standardized process to identify medically stable inpatients, to notify inpatient staff of available COVID-19 vaccine doses, and to coordinate inpatient vaccine administration. The team's goals were to mitigate vaccine waste while safely vaccinating as many patients as possible. Using a unique set of exclusion criteria and clinical judgment, a quality improvement team reviewed patients admitted to medicine teams to determine medical stability. Eligible, interested patients were listed in a secure shared file, and outpatient vaccine clinic staff communicated with inpatient nurse leaders regarding the availability of unadministered doses. Doses were transported to the hospital from the clinic and administered by inpatient nurses. Between January 8 and April 26, 2021, 105 patients were vaccinated with either the Moderna or the Pfizer-BioNTech COVID-19 vaccine during admission. Sixty-nine percent of the patients received a first dose, 27% received a second dose, and 4% received both doses. Forty-two percent of the patients vaccinated while inpatient identified as Black or African American compared with 28% of the vaccinated outpatients. No vaccine-related safety events were reported. This process demonstrates a viable approach to mitigating waste of COVID-19 vaccines and safely, efficiently, and equitably vaccinating an inpatient population.

Purpose To determine the accuracy of incisional biopsy examination to diagnose oral lesions. Materials and Methods This retrospective cohort study was performed to determine the concordance rate between incisional biopsy examination and definitive resection diagnosis for different oral lesions. The study sample was derived from the population of patients who presented to the Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital (Boston, MA) from January 2005 through December 2012. Inclusion criteria were the diagnosis of an oral lesion from an incisional biopsy examination, subsequent diagnosis from the definitive resection of the same lesion, and complete clinical and pathologic patient records. The predictor variables were the origin and size of the lesion. The primary outcome variable was concordance between the provisional incisional biopsy diagnosis and definitive pathologic resection diagnosis. The secondary outcome variable was type of biopsy error for the discordant cases. Incisional biopsy errors were assessed and grouped into 5 categories: 1) sampling error; 2) insufficient tissue for diagnosis; 3) presence of inflammation making diagnosis difficult; 4) artifact; and 5) pathologist discordance. Results A total of 272 patients met the inclusion criteria. The study sample had a mean age of 47.4 years and 55.7% were women. Of these cases, 242 (88.9%) were concordant when comparing the biopsy and final resection pathology reports. At histologic evaluation, 60.0% of discordant findings were attributed to sampling error, 23.3% to pathologist discrepancy, 13.3% to insufficient tissue provided in the biopsy specimen, and 3.4% to inflammation obscuring diagnosis. Overall, concordant cases had a larger average biopsy volume (1.53 cm 3 ) than discordant cases (0.42 cm 3 ). Conclusion The data collected indicate an 88.9% diagnostic concordance with final pathologic results for incisional oral biopsy diagnoses. Sixty percent of discordance was attributed to sampling error when sampled tissue was not representative of the lesion in toto. Multiple-site biopsy specimens and larger-volume samples allowed for a more accurate diagnosis.

Video summaries are a popular way to share important events, but creating good summaries is hard. It requires expertise in both capturing and editing footage. While hiring a professional videographer is possible, this is too costly for most casual events. An alternative is to place 360 video cameras around an event space to capture footage passively and then extract regular field-of-view (RFOV) shots for the summary. This paper focuses on the problem of extracting such RFOV shots. Since we cannot actively control the cameras or the scene, it is hard to create "ideal' shots that adhere strictly to traditional cinematography rules. To better understand the tradeoffs, we study human preferences for static and moving camera RFOV shots generated from 360 footage. From the findings, we derive design guidelines. As a secondary contribution, we use these guidelines to develop automatic algorithms that we demonstrate in a prototype user interface for extracting RFOV shots from 360 videos.

Hutchinson's fundamental niche, defined by the physical and biological environments in which an organism can thrive in the absence of inter-species interactions, is an important theoretical concept in ecology. However, little is known about the overlap between the fundamental niche and the set of conditions species inhabit in nature, and about natural variation in fundamental niche shape and its change as species adapt to their environment. Here, we develop a custom-made dual gradient apparatus to map a cross-section of the fundamental niche for several marine bacterial species within the genus Vibrio based on their temperature and salinity tolerance, and compare tolerance limits to the environment where these species commonly occur. We interpret these niche shapes in light of a conceptual model comprising five basic niche shapes. We find that the fundamental niche encompasses a much wider set of conditions than those strains typically inhabit, especially for salinity. Moreover, though the conditions that strains typically inhabit agree well with the strains' temperature tolerance, they are negatively correlated with the strains' salinity tolerance. Such relationships can arise when the physiological response to different stressors is coupled, and we present evidence for such a coupling between temperature and salinity tolerance. Finally, comparison with well-documented ecological range in V. vulnificus suggests that biotic interactions limit the occurrence of this species at low-temperature-high-salinity conditions. Our findings highlight the complex interplay between the ecological, physiological and evolutionary determinants of niche morphology, and caution against making inferences based on a single ecological factor.

e18004Background: Cancer diagnoses frequently emerge from the emergency setting yet limited literature is published describing this phenomenon. We identified patients who presented with symptoms su...

Hedgehog (Hh) signaling is implicated in bone development and cellular transformation. Here we show that inhibition of Hh pathway activity inhibits tumor growth through effects on the microenvironment. Pharmacologic inhibition of the Hh effector Smoothened (Smo) increased trabecular bone in vivo and inhibited osteoclastogenesis in vitro. In addition, enhanced Hh signaling due to heterozygosity of the Hh inhibitory receptor Patched (Ptch1+/−) increased bone resorption, suggesting direct regulation of osteoclast (OC) activity by the Hh pathway. Ptch1+/− mice had increased bone metastatic and subcutaneous tumor growth, suggesting that increased Hh activation in host cells promoted tumor growth. Subcutaneous growth of Hh-resistant tumor cells was inhibited by LDE225, a novel orally bioavailable SMO antagonist, consistent with effects on tumor microenvironment. Knockdown of the Hh ligand Sonic Hh (SHH) in these cells decreased subcutaneous tumor growth and decreased stromal cell production of interleukin-6, indicating that tumor-derived Hh ligands stimulated tumor growth in a paracrine fashion. Together our findings show that inhibition of the Hh pathway can reduce tumor burden, regardless of tumor Hh responsiveness, through effects on tumor cells, OCs, and stromal cells within the tumor microenvironment. Hh may be a promising therapeutic target for solid cancers and bone metastases. Cancer Res; 72(4); 897–907. ©2011 AACR.

Digital breast tomosynthesis (DBT) is a tomographic technique in which individual slices through the breast are reconstructed from x-ray projection images acquired over a limited angular range. In contrast-enhanced DBT (CE-DBT) functional information can be observed by administration of an x-ray contrast agent. We have investigated the technical requirements necessary to quantitatively analyze CE-DBT exams. Using a simplified physiological model, a maximum aerial concentration of approximately 2.2 mg iodine/cm2 in a 0.5 cm thick breast lesion is expected when administering 70 ml of 320 mg iodine/ml Visipaque-320®. This corresponds to a small change in x-ray transmission; up to 5% for a 4 cm thick compressed breast. We have modeled CE-DBT acquisition by simulating Rh target x-ray spectra from 40 to 49 kV. Comparison of attenuation data of our simulated and measured spectra were found to agree well. We investigated the effect of scatter, patient motion and temporal stability of the detector on quantifying iodine uptake. These parameters were evaluated by means of experiments and theoretical modeling.

Digital breast tomosynthesis (DBT) is a tomographic technique in which individual slices through the breast are reconstructed from x-ray projection images acquired over a limited angular range. In contrast-enhanced DBT (CE-DBT) functional information is observed by administration of an radiographic contrast agent. The uptake of iodine in the breast is very small and causes changes in x-ray transmission that are smaller than 5%. This presents significant technical challenges if quantitative assessment of contrast agent concentration in tissue is desired. We modeled CE-DBT acquisition by simulating x-ray spectra from 40 to 49 kV. Comparison of attenuation data of our simulated and measured spectra were found to agree well. We investigated the effect of patient motion and scatter on iodine uptake. These parameters were evaluated by means of experiments and theoretical modeling.