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The use of three-dimensional printing has been rapidly expanding over the last several decades. Virtual surgical three-dimensional simulation and planning has been shown to increase efficiency and accuracy in various clinical scenarios.
To report the feasibility of three-dimensional printing in paediatric laryngotracheal stenosis and discuss potential applications of three-dimensional printed models in airway surgery.
Retrospective case series in a tertiary care aerodigestive centre.
Three-dimensional printing was undertaken in two cases of paediatric laryngotracheal stenosis. One patient with grade 4 subglottic stenosis with posterior glottic involvement underwent an extended partial cricotracheal reconstruction. Another patient with grade 4 tracheal stenosis underwent tracheal resection and end-to-end anastomosis. Models of both tracheas were printed using PolyJet technology from a Stratasys Connex2 printer.
It is feasible to demonstrate stenosis in three-dimensional printed models, allowing for patient-specific pre-operative surgical simulation. The models serve as an educational tool for patients’ understanding of the surgery, and for teaching residents and fellows.
Emotion dysregulation is a risk factor for the development of a variety of psychopathologic outcomes. In children, irritability, or dysregulated negative affect, has been the primary focus, as it predicts later negative outcomes even in very young children. However, dysregulation of positive emotion is increasingly recognized as a contributor to psychopathology. Here we used an exploratory factor analysis and defined four factors of emotion dysregulation: irritability, excitability, sadness, and anhedonia, in the preschool-age psychiatric assessment collected in a sample of 302 children ages 3–5 years enriched for early onset depression. The irritability and excitability factor scores defined in preschoolers predicted later diagnosis of mood and externalizing disorders when controlling for other factor scores, social adversity, maternal history of mood disorders, and externalizing diagnoses at baseline. The preschool excitability factor score predicted emotion lability in late childhood and early adolescence when controlling for other factor scores, social adversity, and maternal history. Both excitability and irritability factor scores in preschoolers predicted global functioning into the teen years and early adolescence, respectively. These findings underscore the importance of positive, as well as negative, affect dysregulation as early as the preschool years in predicting later psychopathology, which deserves both further study and clinical consideration.
We present a workflow to track icebergs in proglacial fjords using oblique time-lapse photos and the Lucas-Kanade optical flow algorithm. We employ the workflow at LeConte Bay, Alaska, where we ran five time-lapse cameras between April 2016 and September 2017, capturing more than 400 000 photos at frame rates of 0.5–4.0 min−1. Hourly to daily average velocity fields in map coordinates illustrate dynamic currents in the bay, with dominant downfjord velocities (exceeding 0.5 m s−1 intermittently) and several eddies. Comparisons with simultaneous Acoustic Doppler Current Profiler (ADCP) measurements yield best agreement for the uppermost ADCP levels (~ 12 m and above), in line with prevalent small icebergs that trace near-surface currents. Tracking results from multiple cameras compare favorably, although cameras with lower frame rates (0.5 min−1) tend to underestimate high flow speeds. Tests to determine requisite temporal and spatial image resolution confirm the importance of high image frame rates, while spatial resolution is of secondary importance. Application of our procedure to other fjords will be successful if iceberg concentrations are high enough and if the camera frame rates are sufficiently rapid (at least 1 min−1 for conditions similar to LeConte Bay).
Leaf colour characteristics of 730 sweetpotato, Ipomoea batatas (L.) Lam. (Convolvulaceae), plant introduction (PI) accessions from the USDA sweetpotato germplasm collection were evaluated during 2012–2014. Colorimetry data for the abaxial and adaxial leaf surfaces were recorded using a tristimulus colorimeter and the CIE 1976 L*a*b* and CIE L*C*h* colour spaces. Most accessions (725 of 730 PIs) had dark-to-medium green leaves, but two PIs had totally purple leaves, and three PIs had yellow or yellow-green (chartreuse) leaves. For mature, field-grown green leaves, values for the red-green coordinate (a*) averaged −12.4 for the adaxial and −10.4 for the abaxial leaf surface. Values for the blue-yellow coordinate (b*) averaged 17.2 for the adaxial and 17.3 for the abaxial leaf surface. Hue angle (h*) for green leaves averaged 120.9° for the adaxial and 126.2° for the abaxial leaf surface. Colour saturation (Chroma, C*) averaged 21.3 for the adaxial and 20.2 for the abaxial leaf surface. Lightness (L*) averaged 35.4 for the adaxial and 47.2 for the abaxial leaf surface of green leaves. Late in the season, over one-half (53.9%) of the 730 PIs showed some level of purple pigmentation in the leaf lamina. Late-season purple leaves were collected and colour coordinates were recorded for 118 PIs grown in the field. For purple leaves, values for a*, b*, C*, L* and h* averaged 2.3, 6.2, 7.9, 28.2 and 64.4° for the adaxial surface and −1.0, 12.7, 13.9, 43.1 and 87.0° for the abaxial leaf surface, respectively.
We study the shape and motion of gas bubbles in a liquid flowing through a horizontal or slightly inclined thin annulus. Experimental data show that in the horizontal annulus, bubbles develop a unique ‘tadpole-like’ shape with a semi-circular cap and a highly stretched tail. As the annulus is inclined, the bubble tail tends to vanish, resulting in a significant decrease of bubble length. To model the bubble evolution, the thin annulus is conceptualised as a ‘Hele-Shaw’ cell in a curvilinear space. The three-dimensional flow within the cell is represented by a gap-averaged, two-dimensional model, which achieved a close match to the experimental data. The numerical model is further used to investigate the effects of gap thickness and pipe diameter on the bubble behaviour. The mechanism for the semi-circular cap formation is interpreted based on an analogous irrotational flow field around a circular cylinder, based on which a theoretical solution to the bubble velocity is derived. The bubble motion and cap geometry is mainly controlled by the gravitational component perpendicular to the flow direction. The bubble elongation in the horizontal annulus is caused by the buoyancy that moves the bubble to the top of the annulus. However, as the annulus is inclined, the gravitational component parallel to the flow direction becomes important, causing bubble separation at the tail and reduction in bubble length.
Measurements in the infrared wavelength domain allow direct assessment of the physical state and energy balance of cool matter in space, enabling the detailed study of the processes that govern the formation and evolution of stars and planetary systems in galaxies over cosmic time. Previous infrared missions revealed a great deal about the obscured Universe, but were hampered by limited sensitivity.
SPICA takes the next step in infrared observational capability by combining a large 2.5-meter diameter telescope, cooled to below 8 K, with instruments employing ultra-sensitive detectors. A combination of passive cooling and mechanical coolers will be used to cool both the telescope and the instruments. With mechanical coolers the mission lifetime is not limited by the supply of cryogen. With the combination of low telescope background and instruments with state-of-the-art detectors SPICA provides a huge advance on the capabilities of previous missions.
SPICA instruments offer spectral resolving power ranging from R ~50 through 11 000 in the 17–230 μm domain and R ~28.000 spectroscopy between 12 and 18 μm. SPICA will provide efficient 30–37 μm broad band mapping, and small field spectroscopic and polarimetric imaging at 100, 200 and 350 μm. SPICA will provide infrared spectroscopy with an unprecedented sensitivity of ~5 × 10−20 W m−2 (5σ/1 h)—over two orders of magnitude improvement over what earlier missions. This exceptional performance leap, will open entirely new domains in infrared astronomy; galaxy evolution and metal production over cosmic time, dust formation and evolution from very early epochs onwards, the formation history of planetary systems.
To determine which healthcare worker (HCW) roles and patient care activities are associated with acquisition of vancomycin-resistant Enterococcus (VRE) on HCW gloves or gowns after patient care, as a surrogate for transmission to other patients.
Prospective cohort study.
Medical and surgical intensive care units at a tertiary-care academic institution.
VRE-colonized patients on Contact Precautions and their HCWs.
Overall, 94 VRE-colonized patients and 469 HCW–patient interactions were observed. Research staff recorded patient care activities and cultured HCW gloves and gowns for VRE before doffing and exiting patient room.
VRE were isolated from 71 of 469 HCWs’ gloves or gowns (15%) following patient care. Occupational/physical therapists, patient care technicians, nurses, and physicians were more likely than environmental services workers and other HCWs to have contaminated gloves or gowns. Compared to touching the environment alone, the odds ratio (OR) for VRE contamination associated with touching both the patient (or objects in the immediate vicinity of the patient) and environment was 2.78 (95% confidence interval [CI], 0.99–0.77) and the OR associated with touching only the patient (or objects in the immediate vicinity) was 3.65 (95% CI, 1.17–11.41). Independent risk factors for transmission of VRE to HCWs were touching the patient’s skin (OR, 2.18; 95% CI, 1.15–4.13) and transferring the patient into or out of bed (OR, 2.66; 95% CI, 1.15–6.43).
Patient contact is a major risk factor for HCW contamination and subsequent transmission. Interventions should prioritize contact precautions and hand hygiene for HCWs whose activities involve touching the patient.
Thermal resistance across the interface between touching surfaces is critical for many industrial applications. We developed a network model to predict the macroscopic thermal resistance of mechanically contacting surfaces. Contacting interfaces are fractally rough, with small islands of locally intimate contact separated by regions with a wider gas filled boundary gap. Heat flow across the interface is therefore heterogeneous and thus the contact model is based on a network of thermal resistors representing boundary resistance at local contacts and the access resistance for lateral transport to contacts. Molecular dynamics simulations have been performed to characterize boundary resistance of Silicon Alumina interfaces for testing the sensitivity of thermal resistance to contact opening. Boltzmann transport simulations of access resistance in Si are conducted in the ballistic transport regime.
Cholesteatoma is widely considered to be more aggressive in children than adults, yet few studies have directly compared the operative findings and surgical outcomes between these two groups. This study aimed to assess differences between childhood and adult cholesteatoma.
The operative caseload of a single consultant surgeon was reviewed between January 2006 and May 2017 using the online Common Otology Audit database. Extracted data were categorised according to patient age (children, aged below 16 years, and adults, aged 16 years or over) and compared.
This study included data from 71 operations on children and 281 operations on adults, performed for cholesteatoma. Childhood cholesteatoma demonstrated significantly more extension (into the sinus tympani, mastoid antrum and mastoid air cells) and ossicular erosion (of the malleus, incus and stapes superstructure) compared to adults. No significant differences were seen in revision rates, post-operative complications or hearing gain.
Childhood cholesteatoma was more extensive and destructive compared to adults, representing a more aggressive disease in this cohort.
A new family of six ionenes containing aromatic amide linkages has been synthesized from ready available starting materials at scales up to ∼50 g. These ionene-polyamides are all constitutional isomers and vary only in the regiochemistry of the amide linkages (para, meta) and xylyl linkages (ortho, meta, para) which are present in the polymer backbone. This paper details the synthesis of these ionenes and associated characterizations. Ionene-polyamides exhibit relatively low melting points (∼150 oC) allowing them to be readily processed into films and other objects. These ionene-polyamide materials are being developed for further study as polymer membranes for the separations of gases such as CO2, N2, CH4 and H2.
Objectives: Rates of cognitive, academic and behavioral comorbidities are elevated in children with epilepsy. The contribution of environmental and genetic influences to comorbidity risk is not fully understood. This study investigated children with epilepsy, their unaffected siblings, and controls to determine the presence and extent of risk associated with family relatedness across a range of epilepsy comorbidities. Methods: Participants were 346 children (8–18 years), n=180 with recent-onset epilepsy, their unaffected siblings (n=67), and healthy first-degree cousin controls (n=99). Assessments included: (1) Child Behavior Checklist/6-18 (CBCL), (2) Behavior Rating Inventory of Executive Function (BRIEF), (3) history of education and academic services, and (4) lifetime attention deficit hyperactivity disorder (ADHD) diagnosis. Analyses consisted of linear mixed effect models for continuous variables, and logistic mixed models for binary variables. Results: Differences were detected between the three groups of children across all measures (p<.001). For ADHD, academic problems, and executive dysfunction, children with epilepsy exhibited significantly more problems than unaffected siblings and controls; siblings and controls did not differ statistically significantly from each other. For social competence, children with epilepsy and their unaffected siblings displayed more abnormality compared with controls, with no statistically significant difference between children with epilepsy and unaffected siblings. For behavioral problems, children with epilepsy had more abnormality than siblings and controls, but unaffected siblings also exhibited more abnormalities than controls. Conclusions: The contribution of epilepsy and family relatedness varies across specific neurobehavioral comorbidities. Family relatedness was not significantly associated with rates of ADHD, academic problems and executive dysfunction, but was associated with competence and behavioral problems. (JINS, 2018, 24, 1–9)
We present a variational optimization method that can identify the most efficient kinematic dynamo in a sphere, where efficiency is based on the value of a magnetic Reynolds number that uses enstrophy to characterize the inductive effects of the fluid flow. In this large-scale optimization, we restrict the flow to be steady and incompressible, and the boundary of the sphere to be no-slip and electrically insulating. We impose these boundary conditions using a Galerkin method in terms of specifically designed vector field bases. We solve iteratively for the flow field and the accompanying magnetic eigenfunction in order to find the minimal critical magnetic Reynolds number
for the onset of a dynamo. Although nonlinear, this iteration procedure converges to a single solution and there is no evidence that this is not a global optimum. We find that
is at least three times lower than that of any published example of a spherical kinematic dynamo generated by steady flows, and our optimal dynamo clearly operates above the theoretical lower bounds for dynamo action. The corresponding optimal flow has a spatially localized helical structure in the centre of the sphere, and the dominant components are invariant under rotation by
Extinction is the complete loss of a species, but the accuracy of that status depends on the overall information about the species. Dracaena umbraculifera was described in 1797 from a cultivated plant attributed to Mauritius, but repeated surveys failed to relocate it and it was categorized as Extinct on the IUCN Red List. However, several individuals labelled as D. umbraculifera grow in botanical gardens, suggesting that the species’ IUCN status may be inaccurate. The goal of this study was to understand (1) where D. umbraculifera originated, (2) which species are its close relatives, (3) whether it is extinct, and (4) the identity of the botanical garden accessions and whether they have conservation value. We sequenced a cpDNA region of Dracaena from Mauritius, botanical garden accessions labelled as D. umbraculifera, and individuals confirmed to be D. umbraculifera based on morphology, one of which is a living plant in a private garden. We included GenBank accessions of Dracaena from Madagascar and other locations and reconstructed the phylogeny using Bayesian and parsimony approaches. Phylogenies indicated that D. umbraculifera is more closely related to Dracaena reflexa from Madagascar than to Mauritian Dracaena. As anecdotal information indicated that the living D. umbraculifera originated from Madagascar, we conducted field expeditions there and located five wild populations; the species’ IUCN status should therefore be Critically Endangered because < 50 wild individuals remain. Although the identity of many botanical garden samples remains unresolved, this study highlights the importance of living collections for facilitating new discoveries and the importance of documenting and conserving the flora of Madagascar.
Peroxide speciation and formaldehyde measurements have been made on ice cores retrieved from Law Dome, Antarctica. Measurements were made for ice deposited during four different periods: modern, pre-industrial Holocene, early Holocene and Last Glacial Maximum (LGM). The data show modern peroxide levels >50% above pre-industrial levels (at ∼1.6 μmol L−1) and an absence of methyl hydroperoxide (down to a detection threshold of 0.003 μmol L−1). Formaldehyde levels show a 40% increase from pre-industrial to modern times (rising from ∼0.07 μmol L−1 to ∼0.10 μmol L−1), with a further increase and possible seasonality near the surface which we associate with post-depositional processes. Peroxide levels in LGM ice are low, but formaldehyde concentrations are high (at ∼0.13 μmol L−1) relative to modern levels. Similar high levels of formaldehyde are seen in early Holocene ice (∼6900 years BP).
Assessments of biodiversity status are needed to track trends, and the IUCN Red List has become the accepted global standard for documenting the extinction risk of species. Obtaining robust data on population size is an essential component of any assessment of a species’ status, including assessments for the IUCN Red List. Obtaining such estimates is complicated by methodological and logistical issues, which are more pronounced in the case of cryptic species, such as the snow leopard Panthera uncia. Estimates of the total population size of this species have, to date, been based on little more than guesstimates, but a comprehensive summary of recent field research indicates that the conservation status of the snow leopard may be less dire than previously thought. A revised categorization, from Endangered to Vulnerable, on the IUCN Red List was proposed but met some opposition, as did a recent, similar recategorization of the giant panda Ailuropoda melanoleuca. Possible factors motivating such attitudes are discussed. Downlisting on the IUCN Red List indicates that the species concerned is further from extinction, and is always to be welcomed, whether resulting from successful conservation intervention or improved knowledge of status and trends. Celebrating success is important to reinforce the message that conservation works, and to incentivize donors.
Mental Health Systems and Policy: Introduction to Part III
Dennis P. Watson, Assistant Professor, Department of Health Policy and Management, Interim Director, Center for Health Policy,
Erin L. Adams, Doctoral Candidate, Department of Psychology, School of Science, Graduate Research Assistant, Center for Health Policy, School of Public Health, Indiana University - Purdue University Indianapolis,
Joanna R. Jackson, Graduate Research Assistant, Center for Health Policy, Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health
This chapter provides an overview of the history of mental health policy in the United States divided into three periods: (1) the development and establishment of the state asylum as the primary mode of mental health treatment; (2) deinstitutionalization and the move to community-based care; and (3) recovery as the guiding vision of mental health care. Federal involvement is a relatively new development in mental health policy, a fact that has lead to significant fragmentation in the mental health care system. While a number of policies since the 1950s have sought to increase social inclusion and the ability for people with mental illness to control their own lives, lack of support for these policies has resulted in relatively slow actual change. However, recent national reforms have potential to make lasting and substantial change. Watson and colleagues describe these reforms and how they may lead to implementation of recovery-oriented principles by improving mental health care access and service quality. They close with a discussion of potential areas for sociological mental health research related to contemporary health policy. What are the gaps in current mental health policy? How can mental health policy promote recovery for people living with mental health problems?
Historically, there has been a lack of strong federal involvement in US mental health policy making. The result has been a highly fragmented mental health system with significant differences at the state and local levels of government. In this chapter, we provide an overview of the history of US mental health policy from the seventeenth century to the present, with a particular focus on polices affecting people living with serious and persistent mental illness (SPMI). We have divided the chapter into three broad periods of reform. The first period, the late 1700s through the 1940s, was a time marked by increasing social control over the lives of people with mental illness as states started to assume more responsibility for their care. This period culminated with the state psychiatric hospital (also known as the asylum) as the primary locus of mental health treatment. The 1950s–1980s was a time of advocacy leading to the movement of patients from state mental hospitals and into the community. This period was also marked by increased recognition of the rights of people living with mental illness, albeit with relatively few polices or resources to support them.