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I. INTRODUCTION Most law firms have policies and procedures for the preparation and delivery of legal opinion letters to recipients who are not their clients. (1) The policies typically identify [...]

Lower esophageal sphincter achalasia is associated with a higher risk of aspiration during anesthesia. Endoluminal Functional Lumen Imaging Probe (EndoFLIP) is used as an adjunctive tool in both the diagnosis and treatment of achalasia, for which all children require anesthesia. Anesthesia may affect the parameters of the EndoFLIP due to its effect on gut motility. There are no standard anesthesia protocols to help decrease the risk of aspiration and the undesirable effect of anesthesia on EndoFLIP parameters. This study aims to standardize an anesthesia protocol to target both goals. A protocol was developed to address perioperative management in patients undergoing EndoFLIP for any indication to minimize both anesthetic effect on the esophageal motility as well as perioperative complications. A retrospective data analysis was conducted on patients who underwent EndoFLIP at Cincinnati Children's Hospital Medical Center; pre‐ and post‐protocol implementation data including adverse events was compared. Pre‐protocol implementation: 60 cases (median age of 13.8 years, 30 [50%] females) with 2 cases of adverse events (3.3%). Post‐protocol implementation: 71 cases (median age of 14.6 years, 37 [52.1%] females) with no adverse events (0/71 = 0%). In comparison between pre‐ and post‐protocol cases, no significant difference was noted in gender, age, and adverse events. Post‐protocol procedures were found to be significantly shorter (median time of 89 vs. 79 min, p= 0.004). Our anesthesia protocol provides a standardized way of administering anesthesia minimizing impact on EndoFLIP parameters and aspiration for patients with achalasia. EndoFLIP Anesthesia Protocol comparing pre and post operative findings highlighting main preoperative, intraoperative and post operative interventions. Achalasia is associated with a higher risk for aspiration during anesthesia.Management of achalasia includes the use of Endoluminal Functional Lumen Imaging Probe (EndoFLIP) during diagnosis and treatment.Multiple drugs used during anesthesia can impact EndoFLIP parameters.There are no guidelines for anesthesia protocols to minimize aspiration risks and optimize EndoFLIP parameters for achalasia patients. Achalasia is associated with a higher risk for aspiration during anesthesia. Management of achalasia includes the use of Endoluminal Functional Lumen Imaging Probe (EndoFLIP) during diagnosis and treatment. Multiple drugs used during anesthesia can impact EndoFLIP parameters. There are no guidelines for anesthesia protocols to minimize aspiration risks and optimize EndoFLIP parameters for achalasia patients. A proposed anesthesia protocol for children with achalasia undergoing EndoFLIP.Results of a collaborative effort between gastrointestinal and anesthesia to optimize implementation of the protocol‐ pediatric referral center experience.Proposed guidelines may facilitate standardization of achalasia/EndoFLIP anesthesia protocols to minimize complications, optimize management, and provide a format for further research. A proposed anesthesia protocol for children with achalasia undergoing EndoFLIP. Results of a collaborative effort between gastrointestinal and anesthesia to optimize implementation of the protocol‐ pediatric referral center experience. Proposed guidelines may facilitate standardization of achalasia/EndoFLIP anesthesia protocols to minimize complications, optimize management, and provide a format for further research.

ABSTRACTThis paper presents results from a series of survey experiments testing the effects of various arguments on relative evaluations of ranked-choice (RCV) and choose-one ballots. We examine data from the 2020 Collaborative Multiracial Post-Election Survey (CMPS), allowing for comparisons across racial groups. Reformers have emphasized the voter’s ability to have their vote transferred to a lower-ranked candidate as a positive aspect of the system. However, we find that an explanation of RCV’s vote-transfer properties does not increase public support. Furthermore, when given a choice between the single and ranked voting methods, a majority within each racial group prefers the single vote. However, Latino, Asian American, and MENA respondents express a stronger preference for RCV than white respondents. Democrats also evaluate RCV more favorably than Republicans. Furthermore, communicating that RCV helps elect more women and people of color increases support among Democrats but not Republicans across most racial groups. This is consistent with other findings around growing partisan differences in views toward diversity and descriptive representation. Finally, a message emphasizing voter confusion has little impact on public support for RCV. Arguments about the impact of electoral systems are found to influence public preferences more than descriptions of those systems’ key properties.

Machine learning techniques are a driving force for research in various fields, from credit card fraud detection to stock analysis. Recently, a growing interest in increasing human involvement has emerged, with the primary goal of improving the interpretability of machine learning models. Among different techniques, Partial Dependence Plots (PDP) represent one of the main model-agnostic approaches for interpreting how the features influence the prediction of a machine learning model. However, its limitations (i.e., visual interpretation, aggregation of heterogeneous effects, inaccuracy, and computability) could complicate or misdirect the analysis. Moreover, the resulting combinatorial space can be challenging to explore both computationally and cognitively when analyzing the effects of more features at the same time. This article proposes a conceptual framework that enables effective analysis workflows, mitigating state-of-the-art limitations. The proposed framework allows for exploring and refining computed partial dependences, observing incrementally accurate results, and steering the computation of new partial dependences on user-selected subspaces of the combinatorial and intractable space. With this approach, the user can save both computational and cognitive costs, in contrast with the standard monolithic approach that computes all the possible combinations of features on all their domains in batch. The framework is the result of a careful design process involving experts’ knowledge during its validation and informed the development of a prototype, W4SP1, that demonstrates its applicability traversing its different paths. A case study shows the advantages of the proposed approach.

The gastrointestinal (GI) manifestations in children with hypermobile Ehlers–Danlos syndrome/joint hypermobility syndrome (hEDS/JHS) are not well described. We investigated the prevalence of GI disorders in children and young adults with hEDS/JHS through a single‐center retrospective review. Demographic data, clinical history, symptoms, and diagnostic studies were reviewed. Of 435 patients with hEDS/JHS, 66% were females (age 5−28 years). We noted a high prevalence of constipation (61%), dysphagia (32%), dyspepsia and/or gastroparesis (25%), eosinophilic esophagitis (EoE) (21%), and celiac disease (4%) in our cohort. Upper endoscopy and gastric emptying scans had the highest yield to detect abnormalities. Motility studies were abnormal in 31% of the 80 patients who underwent them. Dysphagia symptoms are significantly associated with EoE. Thirty‐three percent of dysphagia patients had EoE, versus 16% of non‐dysphagia patients (p< 0.001). Screening hEDS/JHS patients for GI issues should be routine, with further investigations and referrals guided by identified symptoms. Structural and functional gastrointestinal (GI) disorders have been reported in adults with hypermobile Ehlers−Danlos syndrome/joint hypermobility syndrome (hEDS/JHS).Pediatric studies have explored the association of disorders of gut−brain interaction in hEDS/JHS.Data on GI and motility disorders in pediatric patients have not been fully established, and they may remain overlooked, misdiagnosed, and untreated. Structural and functional gastrointestinal (GI) disorders have been reported in adults with hypermobile Ehlers−Danlos syndrome/joint hypermobility syndrome (hEDS/JHS). Pediatric studies have explored the association of disorders of gut−brain interaction in hEDS/JHS. Data on GI and motility disorders in pediatric patients have not been fully established, and they may remain overlooked, misdiagnosed, and untreated. We found a higher prevalence of constipation (61%), dysphagia (32%), dyspepsia (25%), eosinophilic esophagitis (21%), and celiac disease (4%) in our cohort of patients with hEDS/JHS.Screening hEDS/JHS patients for GI issues should be routine, with further investigations and referrals guided by identified symptoms. We found a higher prevalence of constipation (61%), dysphagia (32%), dyspepsia (25%), eosinophilic esophagitis (21%), and celiac disease (4%) in our cohort of patients with hEDS/JHS. Screening hEDS/JHS patients for GI issues should be routine, with further investigations and referrals guided by identified symptoms.

Transition of Care for Adolescents and Young Adults (AYA) with Neurogastroenterology & Motility (NGM) Disorders. Pediatric neurogastroenterology and motility (NGM) disorders are common, negatively impact quality of life and daily functioning and often continue into adulthood.Structured transition of care programs for adolescents and young adults with pediatric neurogastroenterology and motility disorders are urgently needed. Pediatric neurogastroenterology and motility (NGM) disorders are common, negatively impact quality of life and daily functioning and often continue into adulthood. Structured transition of care programs for adolescents and young adults with pediatric neurogastroenterology and motility disorders are urgently needed. Successful establishment of transition of care programs should lead to decreased hospitalizations, improved follow up with NGM experts, and improved quality of life and daily functioning measures, such as work or school attendance.We propose a NGM transition model which emphasizes pediatric and adult NGM expert collaborative efforts and patient transition‐readiness. Successful establishment of transition of care programs should lead to decreased hospitalizations, improved follow up with NGM experts, and improved quality of life and daily functioning measures, such as work or school attendance. We propose a NGM transition model which emphasizes pediatric and adult NGM expert collaborative efforts and patient transition‐readiness.

Mortality from cutaneous malignant melanoma (CMM) increased in the past, but trends have been favorable in more recent years in many high-income countries. However, incidence has been increasing in several countries. We provided an up-to-date overview of mortality trends from CMM. We analyzed death certification data from the WHO in selected countries worldwide from 1980 to the most recent available calendar years. We also reported incidence data derived from Cancer Incidence in Five Continents from 1990 to 2012. Separate analyses were performed for young adults aged 20–44 and middle-aged adults aged 45–64 years. Mortality from CMM in all age groups showed a favorable pattern in the majority of the countries considered. Mortality trends declined by 40 to 50% in Australia over the last decades, confirming the importance of prevention measures. Considering young adults aged 20–44, Australia, New Zealand and Northern Europe reported the highest death rates for both sexes (>0.90/100 000 in men and >0.60/100 000 in women) while Japan, the Philippines, and Latin America the lowest ones (<0.50/100 000 and <0.35/100 000 in men and women, respectively). Incidence trends were stable or upward in most countries, with higher rates among women. Our study highlights a global reduction of CMM mortality over the last three decades. The increasing awareness of risk factors, mainly related to UV exposure, along with early diagnosis and progress in treatment for advanced disease played pivotal roles in reducing CMM mortality, particularly in Australia.

Pharyngeal contractile integral (PhCI) is the product of mean pharyngeal contractile amplitude, length, and duration, and provides a single metric for the vigor of entire pharyngeal contraction. A major limitation in children is lack of characterization of PhCI on high‐resolution pharyngeal manometry. We aimed to determine and compare the values of PhCI in children with the abnormal and normal videofluoroscopic study of swallow (VFSS). Children who underwent high‐resolution pharyngeal and esophageal manometry (HRPM/HREM), as well as VFSS, were divided into two groups; “normal VFSS” and “abnormal VFSS” groups. PhCI was calculated from the pharyngo‐esophageal manometry analysis software (MMS, v9.5, Laborie Medical Technologies), and compared in these two groups. Of 67 children, 9 had abnormal VFSS (mean age 64 ± 50 months; 66.7% males), while 58 had normal VFSS (mean age 123 ± 55 months; 47% males). The mean PhCI in abnormal and normal VFSS groups was 82.00 ± 51.90 and 147.28 ± 53.89 mmHg.s.cm, respectively (p= 0.001). Subjects with abnormal VFSS were significantly younger than those with normal VFSS (p= 0.003). However, after adjusting for the VFSS result, age was no longer related to PhCI (p= 0.364). In subgroup analysis of children presenting with dysphagia, the mean PhCI in abnormal (9 subjects) and normal (36 subjects) VFSS groups was 82.00 ± 51.90 and 141.86 ± 50.39 mmHg.s.cm, respectively (p= 0.003). PhCI was significantly lower in children with abnormal VFSS than in those with normal VFSS. We did not find a significant impact of age on PhCI in our pediatric populations. Pharyngeal contractile integral (PhCI) is an informative and useful pharyngeal metric for evaluating pharyngeal contraction activity in patients with dysphagia. Pharyngeal contractile integral (PhCI) is an informative and useful pharyngeal metric for evaluating pharyngeal contraction activity in patients with dysphagia. PhCI was significantly lower in children presenting with dysphagia and those with abnormal videofluoroscopic study of swallow (VFSS).The PhCI in children with normal VFSS was lower than previously reported in adults.PhCI may be a useful metric for the diagnosis and monitoring of changes in impairment in pharyngeal swallowing with rehabilitation in children. PhCI was significantly lower in children presenting with dysphagia and those with abnormal videofluoroscopic study of swallow (VFSS). The PhCI in children with normal VFSS was lower than previously reported in adults. PhCI may be a useful metric for the diagnosis and monitoring of changes in impairment in pharyngeal swallowing with rehabilitation in children.

Percutaneous electrical nerve field stimulation (PENFS) has demonstrated promise in single‐center trials for pediatric abdominal pain‐related disorders of gut–brain interaction (DGBI). Our aim was to explore efficacy of PENFS as standard therapy for DGBI in a registry involving multiple pediatric gastroenterology referral centers. This was a multicenter, prospective open‐label registry of children (8–18 years) undergoing PENFS for DGBI at seven tertiary care gastroenterology clinics. DGBI subtypes were classified by Rome IV criteria. Parents and patients completed Abdominal Pain Index (API), Nausea Severity Scale (NSS), and Functional Disability Inventory (FDI) questionnaires before, during therapy and at follow‐up visits up to 1 year later. A total of 292 subjects were included. Majority (74%) were female with median (interquartile range [IQR]) age 16.3 (14.0, 17.7) years. Most (68%) met criteria for functional dyspepsia and 61% had failed ≥4 pharmacologic therapies. API, NSS, and FDI scores showed significant declines within 3 weeks of therapy, persisting long‐term in a subset. Baseline (n= 288) median (IQR) child‐reported API scores decreased from 2.68 (1.84, 3.58) to 1.99 (1.13, 3.27) at 3 weeks (p< 0.001) and 1.81 (0.85, 3.20) at 3 months (n= 75; p< 0.001). NSS scores similarly improved from baseline, persisting at three (n= 74; p< 0.001) and 6 months later (n= 55; p< 0.001). FDI scores displayed similar reductions at 3 months (n= 76; p= 0.01) but not beyond. Parent‐reported scores were consistent with child reports. This large, comprehensive, multicenter registry highlights efficacy of PENFS for gastrointestinal symptoms and functionality for pediatric DGBI. Initial single‐center data demonstrate promising efficacy of percutaneous electrical nerve field stimulation (PENFS) for abdominal pain‐related disorders of gut–brain interaction (DGBI).Presently, there are no large‐scale studies on the effects of PENFS on gastrointestinal symptoms and related functional disability. Initial single‐center data demonstrate promising efficacy of percutaneous electrical nerve field stimulation (PENFS) for abdominal pain‐related disorders of gut–brain interaction (DGBI). Presently, there are no large‐scale studies on the effects of PENFS on gastrointestinal symptoms and related functional disability. This comprehensive, multicenter registry illustrates the beneficial effects of PENFS for pain, nausea, and functional disability in nonselected children affected by DGBI. This comprehensive, multicenter registry illustrates the beneficial effects of PENFS for pain, nausea, and functional disability in nonselected children affected by DGBI.

Atypical atrial flutters often involve complex circuits. Classic methods of identifying ablation targets, including detailed electroanatomical mapping and entrainment within a well-defined isthmus, may not always be sufficient to allow the critical isthmus to be delineated and ablated, with flutter termination and prevention of reinduction.

Discovered over a century ago, the lower Cambrian (Series 2, Stage 4) Cranbrook Lagerstätte of southeastern British Columbia's Eager Formation is one of the oldest Burgess Shale-type deposits in North America. This Konservat-Lagerstätte is rich in olenelloid trilobites, but also yields a very low-diversity soft-bodied fossil assemblage including Tuzoia and Anomalocaris, and a low-diversity ichnofauna. Its scientific study, however, remains limited. A 2015 field-based investigation by the Royal Ontario Museum has revealed new information about the site's biota, depositional environment and taphonomic conditions. Not only is the Cranbrook Lagerstätte significant for early Cambrian biostratigraphy and comparisons with other Burgess Shale-type deposits, it also reveals some of the little-known diversity of life in a distal outer shelf environment during the Cambrian period. Supplementary material: Three supplementary figures (historical map, Tuzoia outlines, Anomalocaris specimens), supplementary material and methods, and a supplementary data file (generic presence/absence matrix) are available at https://doi.org/10.6084/m9.figshare.c.6850810 [ABSTRACT FROM AUTHOR]

Reconfigurable intelligent surfaces (RISs) are planar, almost 2-D, structures that can intelligently manipulate electromagnetic waves by low-cost near passive reflecting elements. RISs are considered a potential enabling technology for the sixth-generation (6G) wireless communication systems due to their capability to tune wireless signals, thus smartly controlling propagation environments. This work has a twofold objective: firstly, we present a systematic methodology for characterizing RISs in the time domain, which rigorously includes propagation delays and mutual coupling among RIS elements; secondly, we analyze the RISs through a convolution-based solver that is enriched by a specialized convolution scheme that enables the analysis of systems with complex linear, nonlinear as well terminations. The proposed approach is validated by extensive numerical evaluations against well-established methods based on both frequency- and time-domain analyses, with a varying number of RIS elements, interdistance, and frequency of operation.

Broad-spectrum anti-infective chemotherapy agents with activity against Trypanosomes, Leishmania,and Mycobacterium tuberculosisspecies were identified from a high-throughput phenotypic screening program of the 456 compounds belonging to the Ty-Box, an in-house industry database. Compound characterization using machine learning approaches enabled the identification and synthesis of 44 compounds with broad-spectrum antiparasitic activity and minimal toxicity against Trypanosoma brucei, Leishmania Infantum,and Trypanosoma cruzi. In vitro studies confirmed the predictive models identified in compound 40which emerged as a new lead, featured by an innovative N-(5-pyrimidinyl)benzenesulfonamide scaffold and promising low micromolar activity against two parasites and low toxicity. Given the volume and complexity of data generated by the diverse high-throughput screening assays performed on the compounds of the Ty-Box library, the chemoinformatic and machine learning tools enabled the selection of compounds eligible for further evaluation of their biological and toxicological activities and aided in the decision-making process toward the design and optimization of the identified lead.

AbstractThe Helium Cooled Pebble Bed breeding blanket of the EU-DEMO foresees continuous processing of a small fraction of the helium coolant in the coolant purification system (CPS) to counteract buildup of tritium and impurities. For this system, two different process variants are currently considered. The first is based on the conversion of all hydrogen species into water using copper oxide beds and the subsequent water adsorption over zeolite molecular sieve (ZMS) beds. The alternative process foresees the direct sorption of hydrogens onto novel ZAO® non-evaporable getter (NEG) materials. The ZMS beds and the NEG beds are operated batchwise, but alternating schemes with an absorption (operation) phase and a desorption (regeneration) phase result in a pseudocontinuous process. Transient process simulations have been developed to evaluate the performance and impact of the different variants on downstream systems in the fuel cycle. In this contribution, these process models for the preconceptual design of both variants are presented and evaluated. For the reference designs proposed for each system, they have been found to satisfy the requirements of achieving 90% efficiency. This modeling then lays the foundation for optimization of the conventional process and outlines further research demand regarding the application of NEG materials needed to progress toward the concept design of the CPS process.

Objective: A major concern with wearable devices aiming to measure the seismocardiogram (SCG) signal is the variability of SCG waveform with the sensor position and a lack of a standard measurement procedure. We propose a method to optimize sensor positioning based on the similarity among waveforms collected through repeated measurements. Method: we design a graph-theoretical model to evaluate the similarity of SCG signals and apply the proposed methodology to signals collected by sensors placed in different positions on the chest. A similarity score returns the optimal measurement position based on the repeatability of SCG waveforms. We tested the methodology on signals collected by using two wearable patches based on optical technology placed in two positions: mitral and aortic valve auscultation site (inter-position analysis). 11 healthy subjects were enrolled in this study. Moreover, we evaluated the influence of the subject's posture on waveform similarity with a view on ambulatory use (inter-posture analysis). Results: the highest similarity among SCG waveforms is obtained with the sensor on the mitral valve and the subject lying down. Conclusions: our approach aims to be a step forward in the optimization of sensor positioning in the field of wearable seismocardiography. We demonstrate that the proposed algorithm is an effective method to estimate similarity among waveforms and outperforms the state-of-the-art in comparing SCG measurement sites. Significance: results obtained from this study can be exploited to design more efficient protocols for SCG recording in both research studies and future clinical examinations.

III-4.2 Recognition and Enforcement of Foreign Judgments in the United States Because the non-U.S. parties to a cross-border agreement may obtain a judgment for breach of the agreement outside the [...]

ABSTRACTThis study aims to investigate the motivations for undergraduate students to pursue studies in culinary arts. The research consists of a mixed methodology, a survey with 94 students from 64 different Brazilian universities, and two focus groups, one group with ten students and one group with twelve students. The students were in their last year of university. The results show that the motivations to pursue a culinary arts degree are related to personal interest, field attractiveness, university degree, and the growing emphasis on culinary shows. The contribution of this research is its innovative approach to examine why students are studying culinary arts.

Metformin is a frequently used anti-diabetic drug. In addition to the well-known modulating properties on glyco-metabolic control, metformin reduces cardiovascular (CV) risk partly independently of its anti-hyperglycaemic effect. The use of ‘new’ anti-diabetic drugs, inhibitors of the renal Na-glucose co-transporter (SGLTs-I or ‘gliflozines’) and GLP-1 receptor agonists (GLP1-RAs), has further contributed to challenge the strictly ‘gluco-centric’ view of diabetic CV disease. Several controlled trials have demonstrated that the cardio-renal benefits of gliflozines and GLP1-RAs are present regardless of the presence of metformin as ‘background’ therapy. The impact on the ‘cardio-renal continuum’ exerted by SGLTs-I was also noted in non-diabetic patients with heart failure and reduced or preserved ventricular function and different levels of renal function. These drugs reduced re-hospitalization, CV mortality, and progression to end-stage renal disease. These clinical acquisitions, implemented by Scientific Societies, have led to a change in the therapeutic approach to diabetic cardio-renal disease. Although metformin still represents a valid therapeutic option to be offered particularly to ‘naïve’ diabetic patients without previous cardio-renal events, SGLTs-I and/or GLP1-RAs emerge as ‘first-line’ drugs in diabetic patients with previous CV events, or at high CV risk, without having to request ‘on board’ metformin therapy.

Strategic planning for pipe renewal and replacement (R&R) is key to saving money, maintaining high‐quality service to customers, and preventing catastrophic infrastructure failures. A proactive capital improvement plan involves condition assessment, risk analysis, project prioritization, and creation of an R&R schedule, giving priority to pipes most in need. Scenario analysis using a powerful simulation model provides a systemwide forecast that is instrumental in planning, budgeting, and making the most of utility assets.

Functional abdominal pain disorders (FAPDs) are common in the pediatric population and are associated with a significant reduction in quality of life. Bidirectional communication of the brain-gut axis plays an important role in pain generation and perception in FAPDs. There is a paucity of data on the best approach to treat this group of disorders, with no Food and Drug Administration (FDA)-approved drugs and scarce research to substantiate the use of most medications. Use of hypnosis in pediatric FAPDs is supported by evidence and has long-term benefits of up to at least 5 years beyond completion of treatment, highlighting the importance of incorporating this therapy into the care of these patients. The mechanisms by which clinical hypnosis is beneficial in the treatment of FAPDs is not completely understood, but there is growing evidence that it impacts functioning of the brain-gut axis, potentially through influence on central pain processing, visceral sensitivity, and motility. The lack of side effects or potential for significant harm and low cost makes it an attractive option compared to pharmacologic therapies. This review addresses current barriers to clinical hypnosis including misconceptions among patients and families, lack of trained clinicians, and questions around insurance reimbursement. The recent use of telemedicine and delivery of hypnosis via audio-visual modalities allow more patients to benefit from this treatment. As the evidence base for hypnosis grows, acceptance and training will likely increase as well. Further research is needed to understand how hypnosis works and to develop tools that predict who is most likely to respond to hypnosis. Studies on cost-effectiveness in comparing hypnosis to other therapies for FAPDs will increase evidence for appropriate healthcare utilization. Because hypnosis has applications beyond pain and is child-friendly with minimal to no risk, hypnosis could be an important therapeutic tool in the wider pediatric gastrointestinal population.

Recent developments in opinion practice provide glimpses of the future. Implementing rules under the JOBS Act (1) can be expected to have an impact on securities law opinions and recent [...]

Chronic constipation occurs frequently in children with autism spectrum disorder (ASD). The primary objective was to determine whether chronic constipation is associated with a higher rate of abnormal colonic motor activity in ASD children than in non-ASD children. A secondary goal was to determine if clinical variables could identify children with ASD at risk for possessing abnormal colonic motility. A retrospective, propensity-matched, case-control study compared colonic manometry (CM) of an ASD cohort and non-ASD controls with chronic constipation. Clinical variables were evaluated as potential predictors for abnormal colonic motility. Fifty-six patients with ASD and 123 controls without the diagnosis of ASD who underwent CM were included. Propensity score resulted in 35 matched cohorts of ASD and controls. The rate of abnormal CM findings between ASD and matched controls (24% vs 20%, P= 0.78) did not differ significantly. A prediction model of abnormal CM that included ASD diagnosis, duration of constipation, and soiling achieved a sensitivity of 0.94 and specificity of 0.65. The risk for abnormal colonic motility increased 11% for every 1-year increase in duration of constipation. Odds for abnormal motility were 30 times higher in ASD children with soiling than controls with soiling (P< 0.0001). Chronic constipation does not appear to be associated with a higher rate of abnormal colonic motility in children with ASD. Clinical information of disease duration and presence of soiling due to constipation show promise in identifying patients with ASD at a greater risk for abnormal colonic motility.

When facing the problem of autonomously learning to achieve multiple goals, researchers typically focus on problems where each goal can be solved using just one policy. However, in environments presenting different contexts, the same goal might need different skills to be solved. These situations pose two challenges: 1) recognize which are the contexts that need different policies to perform the goals and 2) learn the policies to accomplish the same goal in the identified relevant contexts. These two challenges are even harder if faced within an open-ended learning framework where potentially an agent has no information on the environment, possibly not even about the goals it can pursue. We propose a novel robotic architecture, contextual GRAIL (C-GRAIL), that solves these challenges in an integrated fashion. The architecture is able to autonomously detect new relevant contexts and ignore irrelevant ones, on the basis of the decrease of the expected performance for a given goal. Moreover, C-GRAIL can quickly learn the policies for new contexts leveraging on transfer learning techniques. The architecture is tested in a simulated robotic environment involving a robot that autonomously discovers and learns to reach relevant target objects in the presence of multiple obstacles generating several different contexts.

This paper studies the development of interorganisational relationships among technological companies and the influence of belonging to an institutional district. Three levels were established to study the development of those relationships: first, participation in group activities, then the level of shared knowledge, and finally the achievement of joint projects. The study was designed under a mixed methodology with a correlational approach, triangulated by a questionnaire, interviews, and documentary bases for companies located in the technological district of Buenos Aires. The main results showed that expectations of development of the district and the possession of protocols for strategic decision-making significantly encourage cooperative actions, through their influence on the dynamics of trust. The shared knowledge was frequently tacit and mainly due to infrastructure and business partners. The most frequent type of relations was between large and small organisations, reflecting a potential for strategic alliances under co-working structures or business incubators.

The concept of lifelong [1], continual [2], progressive [3], or open-ended [4], [5], [6] learning by artificial agents or robots is of interest to researchers because it permits robots to adapt to multiple tasks over the course of their life and progressively accumulate knowledge [1], [3], [7]. This means that the agent or robot is less likely to become obsolete due to environmental changes, and it may be better equipped to respond to new tasks through the accumulated knowledge. This can include motor skills [8], high-level behaviors [9], vision [10], and social skills [11], among others. On the other hand, the ability to model and thus “understand” lifelong learning is of potential relevance for robots that interact with children or the elderly, or software agents that interact with people in education or training settings.

Networked control systems using wireless links to convey information among sensors, controllers, and actuators greatly benefit from having an accurate estimate of the communication channel condition. To this end, the finite-state Markov channel abstraction allows for reliable channel state estimation. This paper develops a Markov jump linear system representation for wireless networked control with intermittent channel state observation, message losses, and generalized hold-input dropout compensation. Furthermore, it exploits the emerging structural properties of the system to solve the finite-horizon linear quadratic regulation problem efficiently.

AbstractThe European Demonstration Fusion Power Reactor (EU-DEMO) has to operate in a completely tritium self-sufficient mode after initial start-up, which includes producing excess tritium to allow the start-up of other reactors. The initial start-up inventory is mainly dictated by operational inventories in the fuel cycle (FC). Advances in FC technologies and immediate recycling of a large fraction of the torus exhaust gas in the direct internal recycling loop are expected to contribute greatly to an overall low operational inventory. The remainder of the torus exhaust gas, as well as tritium from the blankets, nevertheless requires treatment in the tritium plant in order to perform the necessary purification and isotope rebalancing. Here, the employed systems still feature significant operational inventories and predominantly require steady-state operation in order to maximize their performance. In this paper the operational tritium inventories in the major FC systems are reported based on the pre-concept FC design. Additionally, major dependencies of these inventories on key design drivers of the FC are discussed. It is predicted that the EU-DEMO FC will be able to operate with an overall tritium inventory of less than 2 kg.

Electrostriction is a property of dielectric materials whereby an applied electric field induces a mechanical deformation proportional to the square of that field. The magnitude of the effect is usually minuscule (<10–19m2V–2for simple oxides). However, symmetry-breaking phenomena at the interfaces can offer an efficient strategy for the design of new properties1,2. Here we report an engineered electrostrictive effect via the epitaxial deposition of alternating layers of Gd2O3-doped CeO2and Er2O3-stabilized δ-Bi2O3with atomically controlled interfaces on NdGaO3substrates. The value of the electrostriction coefficient achieved is 2.38 × 10–14m2V–2, exceeding the best known relaxor ferroelectrics by three orders of magnitude. Our theoretical calculations indicate that this greatly enhanced electrostriction arises from coherent strain imparted by interfacial lattice discontinuity. These artificial heterostructures open a new avenue for the design and manipulation of electrostrictive materials and devices for nano/micro actuation and cutting-edge sensors.

Experimental studies on new host-parasite systems involving farmed fish can contribute to our understanding of the host behavioural changes associated with parasite infections, as predicted by the host manipulation hypothesis. This has applied relevance because in offshore farms, intermediate hosts of Anisakisnematodes may come into contact with farmed species, with an actual risk of infection. It could therefore be useful to identify behavioural indicators of infection status to monitor animal health and develop adequate countermeasures. Spontaneous activity, sociability, feeding, predatory response and boldness were evaluated in the three weeks following the infection in farmed sea bass (Dicentrarchus labrax) experimentally infected by Anisakis pegreffiilarvae. Infected animals displayed a significant increase in food intake that did not affect body weight gain. They also showed increased interest towards a prey model and towards food in a risky feeding situation. While supporting the hypothesis of increased energy drain from infection that promotes increased investment in foraging rather than active host manipulation, the observed changes could constitute preliminary behavioural indicators of parasite infection in farmed fish.

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Q: Let's discuss urethral stricture. Traditionally, urethral dilation or direct vision internal urethrotomy (DVIU), whether done with a cold knife or laser, has been part of a urologist's practice. How [...]

There is a bidirectional relationship between sleep and pain disturbances. Sleep disturbances increase the risk for chronic pain while chronic pain can also interfere with sleep. Hence, we aimed to determine subjective sleep characteristics of children with Functional Abdominal Pain Disorders (FAPD) compared to healthy peers and correlate with GI symptoms. We included children ages 11-18y without a diagnosis of sleep or organic GI disorder from a large public school. Participants completed demographics, sleep history, and validated questionnaires: Rome 4, sleep quality (ASWS), insomnia severity (PISI), sleep disturbance (SD), sleep related impairment (SRI) and daytime sleepiness (ESS). Cases filled the abdominal pain index, anxiety, depression (PROMIS) and functional disability (FDI). Parents filled sleep hygiene metrics (SHIP). FAPD cases were matched 1:1 with controls based on age and gender. Of 120 children (60 cases and 60 controls, mean age 13.9 ± 1.9y), children with FAPD had poor sleep quality (p<0.0001), higher insomnia severity (p=0.001), sleep disturbance (p<0.0001), sleep related impairment (p=0.0001), daytime sleepiness (p=0.002), sleep hygiene (p=0.01), gasping (p=0.03) and nightmares (p=0.01) than healthy peers. Total sleep time, rates of snoring, restless legs, pre-sleep activity and caffeine consumption did not differ between the groups (p>0.05). Poor sleep quality and higher insomnia severity correlated with worse abdominal pain (r=-0.41 and 0.41 respectively). Children with FAPD have worse sleep parameters than healthy peers which correlate with abdominal pain. Future studies are needed to identify possible mechanisms by which sleep disturbances affect abdominal pain and vice versa. Funded by NIH (1K23DK135797-01).

Particle accelerators and storage rings have been transformative instruments of discovery, and, for many applications, innovations in particle-beam cooling have been a principal driver of that success1. Stochastic cooling (SC), one of the most important conceptual and technological advances in this area2–6, cools a beam through granular sampling and correction of its phase-space structure, thus bearing resemblance to a ‘Maxwell’s demon’. The extension of SC from the microwave regime up to optical frequencies and bandwidths has long been pursued, as it could increase the achievable cooling rates by three to four orders of magnitude and provide a powerful tool for future accelerators. First proposed nearly 30 years ago, optical stochastic cooling (OSC) replaces the conventional microwave elements of SC with optical-frequency analogues and is, in principle, compatible with any species of charged-particle beam7,8. Here we describe a demonstration of OSC in a proof-of-principle experiment at the Fermi National Accelerator Laboratory’s Integrable Optics Test Accelerator9,10. The experiment used 100-MeV electrons and a non-amplified configuration of OSC with a radiation wavelength of 950 nm, and achieved strong, simultaneous cooling of the beam in all degrees of freedom. This realization of SC at optical frequencies serves as a foundation for more advanced experiments with high-gain optical amplification, and advances opportunities for future operational OSC systems with potential benefit to a broad user community in the accelerator-based sciences.