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The risk of infection after heart transplantation is highest within the first year and represents the leading cause of early mortality. In this cohort of patients enrolled in the Outcomes AlloMap Registry (OAR), we sought to describe infection episodes (IEp) resulting in hospitalization, in the early (<1 year) and late (≥1 year) post-transplant period and determine the impact of immunosuppression on incidence of infection. The primary aim was to assess the incidence and nature of IEp. The secondary aim was to evaluate the effect of potential risk factors, such as recipient age; sex; body mass index; panel-reactive antibodies; cytomegalovirus (CMV) primary mismatch; prednisone, tacrolimus, and sirolimus levels; and gene expression profile (GEP) score, in the development of IEp. The OAR comprises 1,504 patients, of whom 220 patients (14.6%) had an IEp during a median follow-up period of 382 days (interquartile range [IQR] 230 to 579 days). The cause-specific 5-year hazard ratio for any infection was 2.029 (p = 0.12). The pattern of early infection was consistent with nosocomial and opportunistic causes, whereas later infection was consistent with late-onset opportunistic and community-acquired etiologies. Sixty-two percent of the infections occurred early. In the time-dependent analysis, higher prednisone dose (log prednisone, hazard ratio [HR] 1.30, p = 0.022) was the most significant risk factor for all IEp. In the OAR cohort, the majority of infections occurred within 1 year after transplantation. Clinicians may consider more aggressive prednisone withdrawal in low-risk patients to reduce IEp. [ABSTRACT FROM AUTHOR]

• Belief structures provide more information than belief content for changing beliefs. • A new belief structure, adaptive idealist, is introduced. • An adaptive idealist interprets experiences and vocabulary to justify beliefs. One goal of teacher mathematics education is to transform teachers' beliefs to more closely align with beliefs that promote desired teaching practices. However, beliefs are difficult to change. A construct that helps to explain how and why mathematics teachers' beliefs change is that of belief structures (Cooney et al., 1998). We expand upon belief structures to add a new construct: adaptive idealist. In this case study, we used information gleaned from interviews and reflective papers to introduce a prospective secondary mathematics teacher, describe her beliefs and shifts in beliefs, identify a resistance to change that resonated with our other experiences, and conclude that this new belief structure allows us to explain her reactions and interpretations within our secondary mathematics education program. [ABSTRACT FROM AUTHOR]

Teratological diagnosis in polyplacophorans has mostly been based on primary structure (Chiton scleritome) with four types (hypermerism, hypomerism, coalescence and splitting), including some deformities in plates; however, diagnoses are hardly detailed for each sclerite. As part of a monthly research campaign conducted by a year investigating Chiton articulatus , we found several cases with a complex combination of abnormalities (chiton scleritome + sclerites) that complement the previous classification. Identification and diagnosis of abnormalities were assigned in terms of sclerite number, number of slits per side in the insertion area of intermediate sclerites and the merging grade between sclerites. Slit and slit-ray numbers were baseline to identify combination of abnormalities; the slit formula of Chiton articulatus is 13–18[I]/1[II-VII]/16–22[VIII]. We found four abnormality cases with combinations among them: a) perfect hypomerism, b) heterogeneous coalescence, c) homogeneous coalescence, d) imperfect hypermerism. Heterogeneous coalescence was most common abnormality, with a different merging degree between sclerites and with specimens showing combinations of abnormal states such as: normality/coalescence, coalescence/hypomerism, coalescence/hypermerism and normality/hypermerism; so these complex abnormalities can generates asymmetry between the right and left side of a chiton. We postulate that coalescence is an intermediate step toward perfect hypomerism or perfect hypermerism. The width/length ratio suggests that an abnormal chiton increases its width to compensate and retain a normal body appearance despite different degrees of abnormal development. [ABSTRACT FROM AUTHOR]

Study Objective: In this video, we describe a 5-step surgical technique that allows us to safely incise and aspirate the content of large ovarian cysts through a single-port laparoscopic incision. This allows performing laparoscopic oophorectomies instead of large xipho-pubic laparotomies.Design: A stepwise demonstration of the technique with narrated video footage.Setting: Ovarian masses, especially cysts, are common gynecologic conditions [1]. However, depending on their size, large adnexal cysts are usually managed with transverse or midline laparotomies [2]. This is to prevent cyst ruptures and abdominal contamination and ensure oncological safety of the procedure [3-5]. Different leak-proof aspiration techniques have been described in the literature allowing for safe large cyst aspiration and adnexectomy through a mini-laparotomy incision or via laparoscopy [2,3,6-10]. We describe a 5-step surgical technique allowing for closed aspiration of ovarian intracystic fluid and adnexectomy while respecting oncological safety.Interventions: Step 1: Perform diagnostic laparoscopy to rule out peritoneal carcinomatosis contraindicating this procedure and then after cyst exposition, thoroughly dry the cyst wall. Step 1 Bis: Cut the cuff of a sterile glove to prepare a square piece of membrane. Step 2: Place a protective gauze and then apply the surgical glue to the ovarian cyst wall followed by the glove/membrane application. Perform a purse suture through the glove/membrane and the ovarian wall superficially to ensure further adhesion and prevent ovarian fluid spillage. Step 3: Incise the ovarian wall, introduce the aspiration cannula and tighten the purse suture to aspirate the cystic fluid. Step 4: After aspiration is complete, tighten the suture and close the glove to guarantee a closed space and prevent abdominal contamination. Step 5: Perform laparoscopic oophorectomy or cystectomy. Safely remove the specimen in an endoscopic retrieval bag through the trocar incision.Conclusion: This technique allows safe laparoscopic large ovarian cysts resections while respecting oncologic safety and preventing intra-abdominal spillage and contamination. [ABSTRACT FROM AUTHOR]

• ENVI-met is validated to analyze the effect of albedo on courtyard microclimate. • Albedo of surfaces is found to have little effect on courtyard air temperature. • Albedo has an important effect on surface temperature, MRT and comfort. • High albedo of the walls reduces surface temperature but increases MRT. • Medium-range albedo is recommended to balance positive and negative effects. The Urban Heat Island (UHI) effect represents a threat to the well-being of cities. Cities must adapt to this phenomenon, prioritizing the improvement of outdoor environment quality. Urban materials have a great impact on outdoor environment quality, energy demand, and citizens' well-being. Based on the literature, it can be stated that changing the albedo of on-site materials (pavements, facades) is a relevant strategy. The environmental impact of reflective materials from buildings to urban microclimate has been widely discussed in the literature. However, few publications assess the role of albedo in inner courtyards. This work uses simulation results to evaluate the impact of different surface albedo on the thermal performance and comfort of a courtyard in Seville. To do so, the simulation tool ENVI-met, one of the most widely used for outdoor spaces, is validated through a comparison with monitoring results. In conclusion, high reflectance compromises user comfort up to 5 °C of PET despite the fact that the use of high albedo on surfaces reduces surface temperature up to 25 °C in comparison with low albedo as it accumulates less heat by reflecting more solar radiation. Some of the recommendations given include the use of medium albedo (around 0.4) on walls to balance positive and negative effects, and high albedo on the pavements (above 0.7). [ABSTRACT FROM AUTHOR]

Abstract: The process of designing and calculating railway catenary infrastructure, as the way it is carried out currently, is very complex and time consuming. It is necessary expert knowledge of different fields, like design and structural calculus, technical security, legal normative, topography, etc. This process consists of several stages aimed at choosing a design, checking requirements, and calculating structural feasibility, so the communication among the experts may be quite slow. In order to reduce time and effort invested in this process, we propose a system that allows to automate its stages and tasks. Our system provides a valid solution per structure, that complies with design and structural constraints, and with existing railway regulations. The proposed system has been integrated in a high-productivity software tool, that avoids human mistakes due to hand-calculation, allows users a fast design and calculation, and exploits the ability of current computers to run tasks concurrently so as to speed up the process. The computational performance and complexity of the tool, as well as statistics values, are analysed by designing and calculating up to 2048 heterogeneous support structures. Besides, the tool is evaluated through a study case based on a real railway route, obtaining an overall improvement of 82.33% in time invested over the existing process. [Copyright &y& Elsevier]

Abstract: Background: The use of propofol during colonoscopy has become more widespread. To increase availability while maintaining quality and decreasing costs, European Guidelines have been issued for non-anesthesiologist administration of propofol (NAAP). We aimed to assess the current use of propofol during screening colonoscopy. Methods: International survey. Results: Eighty-four questionnaires were collected from endoscopists practicing in 29 countries. Practices were most often located in high-volume community hospitals (Italy, Belgium, Spain, Netherlands in half cases). An anesthesiologist was regularly present in the Endoscopy Unit of 69.0% survey respondents. In low-risk (ASA classification, 1–2) patients, propofol, benzodiazepine+opioids and benzodiazepine alone were used in 45%, 31% and 14% of screening colonoscopies, respectively. Propofol was associated with the highest endoscopist satisfaction (score on a 10-point visual analogue scale, 9.2±1.2 vs. 5.5±1.9 and 4.7±2.0 for benzodiazepine+opioids and benzodiazepine alone, respectively; P <0.0001). NAAP was used by 29.9% of respondents in 9 countries and approximately two-thirds of other endoscopists would consider implementing NAAP. Main reasons for not considering NAAP implementation were medico-legal issues and cost. Conclusion: Propofol provides the highest endoscopist satisfaction but it is used in less than half of screening colonoscopies. Propofol is administered by non-anesthesiologists in one-third of settings; its implementation is foreseen by a majority of endoscopists who do not currently use it. [Copyright &y& Elsevier]

Abstract: This contribution discusses the critical care management of the vascular patient. [Copyright &y& Elsevier]

Abstract: Patients presenting for vascular surgery often suffer from generalized atherosclerosis and are likely to require intensive care. Changing demographics and recent advances mean an increasing number and variety of operations are being performed on an increasingly frail and older population. Some general principles of critical care medicine are introduced. The pathophysiology of some common is discussed. Specific concepts to critical care are explored. [Copyright &y& Elsevier]

A new process called Forcespinning™ has been developed to make nanofibers from a wide range of materials. This new method uses centrifugal force, rather than electrostatic force as in the electrospinning process. The Forcespinning™ method uses either solutions or solid materials that are solution or melt spun into nanofibers. Key parameters to control the geometry and morphology of the nanofibers include rotational speed of the spinneret, collection system and temperature. Orifices of the spinneret can have arbitrary geometric shapes to provide corresponding cross-section of nanofibers. The Forcespinning™ method has been successfully used to make nanofibers of poly-ethylene oxide, poly-lactic acid, bismuth, polypropylene, acrylonitrile-butadiene-styrene, polyvinyl pyrrolidone, and polystyrene among others. [ABSTRACT FROM AUTHOR]