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Corneal ulcers are a common cause of blindness in low-income and middle-income countries, usually resulting from traumatic corneal abrasions during agricultural work. Antimicrobial prophylaxis of corneal abrasions can help prevent corneal ulcers, but delays in the initiation of therapy are frequent. We aimed to assess whether a community-based programme for corneal ulcer prevention would reduce the incidence of corneal ulceration.A cluster-randomised trial was performed in village development committees (VDCs) in Nepal. VDCs in the catchment area of Bharatpur Eye Hospital, Nepal with less than 15 000 people were eligible for inclusion. We randomly assigned (1:1) VDCs to either an intervention group or a control group. In the intervention VDCs, existing female community health volunteers (FCHVs) were trained to diagnose corneal abrasions and provide a 3-day course of ophthalmic antimicrobials to their patients. In the control VDCs, FCHVs did not provide this intervention. Participants were not masked given the nature of the intervention. Both groups were followed up for 3 years for photographic evidence of corneal ulceration. The primary outcome was the incidence of corneal ulceration, determined by masked assessment of corneal photographs. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01969786.We assessed 112 VDCs, of which 24 were enrolled. The study was performed between Feb 4, 2014, and Oct 20, 2017. 12 VDCs were randomly assigned to the intervention group and 12 to the control group. 252 539 individuals were included in the study (130 579 in the intervention group and 121 960 in the control group). FCHVs diagnosed and provided antimicrobials for 4777 corneal abrasions. The census identified 289 corneal ulcers among 246 893 person-years in the intervention group (incidence 1·21 cases [95% CI 0·85-1·74] per 1000 person-years) and 262 corneal ulcers among 239 170 person-years in the control group (incidence 1·18 cases [0·82-1·70] per 1000 person-years; incidence rate ratio 1·03 [95% CI 0·63-1·67]; p=0·93). Medication allergy was self-reported in 0·2% of participants.We did not detect a reduction in the incidence of corneal ulceration during the first 3 years of a community-based corneal ulcer prevention programme. Further study might be warranted in more rural areas where basic eye care facilities are not available.National Eye Institute.

In the present era of data-driven architectures like 5G, Internet of things (IoT), Artificial Intelligence (AI), etc, the requirement of fast-switchable memory storage is more than ever. Oxide resistive switches are considered to be a primary choice in the non-volatile memory design. In this work, we have engineered the conventional metal-insulator-metal (MIM) structure of an oxide memristor (Ag/ZnO/ITO) by inducing an additional oxide layer La0.7Sr0.3MnO3 (LSMO) at the interface between the active layer (ZnO) and Ag electrode. The presence of LSMO acts as a reservoir for the oxygen vacancies, easing the conducting filament formation process in ZnO, thereby enabling drastic improvement of the switching performance and offering reliable endurance over multiple switching cycles. First-principles-based calculations suggested the role of Oxygen vacancies in controlling the electronic state of ZnO and formation of vacancies in the resistive switching process, which is in agreement with the experimental observation. The current results pave ways for improving the switching performance of resistive memory circuits through simple structural engineering incorporation, which lies at the heart of oxide electronics.

The presence of metatarsus adductus (MTA) adds complexity to the diagnosis and treatment of hallux valgus (HV). Identification and careful analysis of these combined deformities is of paramount importance. The inability to completely correct HV and an increased incidence of recurrence has been established when MTA deformity is present. We present an option for correction of the combined deformities with multiplanar angular correction arthrodesis of the first, second, and third tarsometatarsal (TMT) joints.

Successful deformity correction utilizing first metatarsophalangeal (MTP) fusion for hallux valgus with concomitant degenerative changes of the first MTP joint is well documented. Currently, there is limited discussion in the literature focusing on triplanar correction of the first MTP arthrodesis. Presented is a novel approach for triplane correction and fusion of the first MTP joint utilizing a biplanar locked plating system.

Introduction Targeted endodontic microsurgery (TEMS) replaces freehand carbide or diamond bur osteotomy and root-end resection with a guided approach using an end-cutting trephine bur rotated within a guide tube. TEMS departs from traditional endodontic microsurgery in osteotomy size, control of resection level and bevel, surgical time, and resection method; yet, the impact of these departures on clinical outcomes has yet to be assessed. The aim of this study was to assess clinical outcomes of TEMS surgeries at least 1 year after treatment. Methods Potential cases were retrospectively identified from a secure database of all patients who received TEMS in the Air Force Postgraduate Dental School from June 2017–May 2019 with a postsurgical follow-up examination at 1 year or beyond (23 patients with 24 teeth). Two board-certified endodontists completed a calibration exercise before assessing radiographs. A retrospective outcomes assessment was conducted considering follow-up clinical and radiographic findings to assign 1 of 3 healing designations: complete healing, reductive healing, or failure. Results Combined clinical and radiographic data led to 20 designations of complete healing, 2 designations of reductive healing, and 2 failures (91.7% success rate). Considered alone, radiographic criteria for complete healing were met for 20 cases, reductive healing for 3 cases, and radiographic failure for 1 case. Conclusions This limited retrospective outcomes assessment is an early indication that TEMS-guided trephine bur root-end resection leads to similar success as is established for freehand carbide and diamond bur resection. Controlled clinical trials with long-term follow-up are warranted.

Van der Waals heterostructure made of various Two-dimensional (2D) layered materials can offer structural versatility and engineered functionality of the constituent layers, Graphene (Gr) and hexagonal boron nitride (BN) combination being a very popular example. On the other hand, rapid detection and sequencing of various DNA/RNA nucleobases is a very promising challenge of modern day medical science. In this work, we have investigated the behaviour of Gr, BN and their heterostructure based single electron transistor (SET) devices for the sensing/detection of such nucleobases. The electrostatics, adsorption, switching and transport behaviour etc. have been studied using first-principles based calculations in respective cases. It was observed that both graphene and BN layers offer large binding strength for the nucleobases, keeping the electronic properties undisturbed. The presence of a specific molecule within the SET can be identified from respective line scans and normalised differential conductance behaviour obtained from the charge stability diagrams. The current investigation offers a novel detection methodology for various DNA/RNA nucleobases, which is very energy efficient, offers superior detection sensitivity and wide temperature range of operation.

The transcription factor Hypermethylated in Cancer 1 (HIC1) is associated with both tumorigenesis and the complex human developmental disorder Miller-Dieker Syndrome. While many studies have characterized HIC1 as a tumor suppressor, HIC1 function in development is less understood. Loss-of-function mouse alleles show embryonic lethality accompanied with developmental defects, including craniofacial abnormalities that are reminiscent of human Miller-Dieker Syndrome patients. However, the tissue origin of the defects has not been reported. In this study, we use the power of the Xenopus laevis model system to explore Hic1 function in early development. We show that hic1 mRNA is expressed throughout early Xenopus development and has a spatial distribution within the neural plate border and in migrating neural crest cells in branchial arches. Targeted manipulation of hic1 levels in the dorsal ectoderm that gives rise to neural and neural crest tissues reveals that both overexpression and knockdown of hic1 result in craniofacial defects with malformations of the craniofacial cartilages. Neural crest specification is not affected by altered hic1 levels, but migration of the cranial neural crest is impaired both in vivo and in tissue explants. Mechanistically, we find that Hic1 regulates cadherin expression profiles and canonical Wnt signaling. Taken together, these results identify Hic1 as a novel regulator of the canonical Wnt pathway during neural crest migration.

Targeted endodontic microsurgery (TEMS) combines a precisely designed 3-dimensional (3D)-printed surgical guide with a trephine bur for safe and efficient osteotomy and root-end resection. The TEMS digital workflow converts the patient's anatomy into digital data in 4 steps. First, bone, teeth, and neurovascular spaces are rendered with cone-beam computed tomographic imaging. Next, crowns and soft tissues are rendered with an intraoral optical scan, a benchtop optical scan of an impression or cast, or a cone-beam computed tomographic scan of an impression or cast. Third, these renderings are merged within design software to create a 3D construction containing a virtual model. Finally, guide design is performed on the virtual model for 3D printing. A significant gap in knowledge exists in that digital workflow principles and considerations are not documented in the endodontic literature. The aim of this article is to describe TEMS digital workflow guiding principles.

Purpose To determine if there is a benefit to adjuvant corneal crosslinking (CXL) and to compare natamycin versus amphotericin B for filamentous fungal keratitis. Design Outcome-masked, 2×2 factorial design, randomized controlled clinical trial. Participants Consecutive patients presenting with moderate vision loss from a smear-positive fungal ulcer at Aravind Eye Hospital, Madurai, India. Methods Study eyes were randomized to 1 of 4 treatment combinations using an adaptive randomization protocol. The treatment arms included (1) topical natamycin 5% alone, (2) topical natamycin 5% plus CXL, (3) topical amphotericin B 0.15% alone, and (4) topical amphotericin 0.15% plus CXL. Main Outcome Measures The primary outcome of the trial was microbiological cure at 24 hours on repeat culture. Secondary outcomes included best spectacle-corrected visual acuity (BSCVA) at 3 weeks and 3 months, percentage of study participants with epithelial healing at 3 days, 3 weeks, and 3 months, infiltrate or scar size at 3 weeks and 3 months, 3-day smear and culture, and adverse events. Results Those randomized to CXL regardless of medication (topical natamycin or amphotericin) had 1.32-fold increased odds of 24-hour culture positivity, although this was not statistically significant (95% confidence interval [CI], 0.57–3.06; P = 0.51). We were also unable to find a difference in 24-hour culture positivity between those randomized to amphotericin and those randomized to natamycin when evaluating as a group regardless of whether or not they received CXL (coefficient 1.10; 95% CI, 0.47–2.54; P = 0.84). The BSCVA was approximately 0.22 logarithm of the minimum angle of resolution (logMAR) (2.2 Snellen lines) worse on average at 3 weeks among those receiving CXL regardless of medication (95% CI, −0.04 to 0.40; P = 0.04) and 0.32 logMAR (3.2 Snellen lines) worse visual acuity at 3 months after controlling for baseline visual acuity (95% CI, 0.03–0.54; P = 0.02). There was no difference in infiltrate or scar size, percentage of epithelialized or adverse events when comparing CXL with no CXL or the 2 topical medications. Conclusions There appears to be no benefit of adjuvant CXL in the primary treatment of moderate filamentous fungal ulcers, and it may result in decreased visual acuity.

Cholinergic degeneration is a key feature of dementia in neurodegenerative conditions including Alzheimer's disease (AD) and Parkinson's disease (PD). Quantitative electro-encephalography (EEG) metrics are altered in both conditions from early stages, and recent research in people with Lewy body and AD dementia suggests these changes may be associated with atrophy in cholinergic basal forebrain nuclei (cBF). To determine if these relationships exist in predementia stages of neurodegenerative conditions, we studied resting-state EEG and in vivo cBF volumes in 31 people with PD (without dementia), 21 people with mild cognitive impairment (MCI), and 21 age-matched controls. People with PD showed increased power in slower frequencies and reduced alpha reactivity compared to controls. Volumes of cholinergic cell clusters corresponding to the medial septum and vertical and horizontal limb of the diagonal band, and the posterior nucleus basalis of Meynert, correlated positively with; alpha reactivity in people with PD (p< 0.01); and pre-alpha power in people with MCI (p< 0.05). These results suggest that alpha reactivity and pre-alpha power are related to changes in cBF volumes in MCI and PD without dementia.

Ventilatory and neuroendocrine counter-regulatory responses during hypoglycaemia are essential in order to maintain glycolysis and prevent rises in PaCO2 leading to systemic acidosis. The mammalian carotid body has emerged as an important driver of hyperpnoea and glucoregulation in hypoglycaemia. However, the adequate stimulus for CB stimulation in hypoglycaemia has remained controversial for over a decade. The recent finding that adrenaline is a physiological activator of CB in hypoglycaemia raises the intriguing possibility that CB stimulation and hyperpnoea may be necessary to maintain pH in other adrenaline-related hypermetabolic states such as exercise. This review will therefore focus on 1) The important functional contribution of the CB in the counter-regulatory and ventilatory response to hypoglycaemia, 2) the proposed mechanisms that cause CB stimulation in hypoglycaemia including hormonal activation by adrenaline and direct low glucose sensing and 3) the possible pathological consequences of repetitive CB activation by adrenaline that could potentially be targeted to reduce CB-mediated cardiovascular disease.

Indoor shrimp production systems allow production of fresh shrimp year-round near specific markets. However, there is typically little to no natural light available, and it is unclear whether artificial lighting may benefit systems. This study examined the effects of supplemental light-emitting diode (LED) lighting, designed for plant growth, on shrimp (Litopenaeus vannamei) production, water quality, and nutritional dynamics in intensive indoor shrimp systems. Four 1-m3 round tanks with settling chambers and external biofilters were assigned to one of three treatments. One treatment received 24 h of lighting per day (Full Light, FL), another had 12 h of lighting (Partial Light, PL), and the third treatment had no supplemental lighting provided (No Extra Light, NL). All tanks were stocked with 250 shrimp with an average initial weight of 1.2 g and were harvested after 84 days. Shrimp FCR was significantly lower and total biomass was significantly higher in the FL treatment compared with PL and NL treatments. Growth rate and final individual weight were significantly greater in FL and PL treatments, and survival was significantly higher in the FL treatment than the PL treatment. Turbidity, suspended solids, and nitrate concentration were significantly lower in the FL treatment versus PL and NL treatments. Shrimp in the FL and PL treatments contained significantly higher concentrations of n-6 fatty acids and lower docosahexaenoic acid than NL shrimp. The results of this study indicate that supplemental lighting in intensive indoor shrimp systems can improve shrimp production and have effects on biofloc and shrimp nutritional characteristics.

ANCA-associated vasculitides (AAV) represent a group of diagnoses, including granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis (MPA). Most commonly, they present initially with ENT-associated symptomatology, and therefore they often pose a diagnostic challenge. We aim to present our one-year experience in the joint management of AAV in a multi-disciplinary setting.We performed a retrospective analysis based on the records of 39 patients who were seen in the joint clinic, during a period of one year.After clinical assessment, 13 patients had changes made to their ENT treatment, 2 had some changes in their immunosuppression, while 11 had changes in both ENT and Rheumatology treatment. Six patients did not require any alterations to their therapeutic scheme. On average three separate appointments were reduced to a single appointment in the joint clinic where definitive treatment decisions were made. This led to significant cost reductions.Cost-effectiveness, patient satisfaction, rapid multi-disciplinary evaluation, avoidance of unnecessary immunosuppression, patient education and medical training are only a few of the many advantages of this proposed joint service.

A novel computational method is developed to calculate the mass bias of orthogonal acceleration time-of-flight mass spectrometers (OA-TOFMS) by evaluating the m/z-dependent transmission efficiency with which ions strike the surface of the detector and the m/z-dependent ion sampling efficiency with which ions are selected for mass analysis. The theory considers the initial ion energy distribution of the primary ion beam and utilizes mathematical convolution to establish the subsequent trajectory of all ions extracted into the OA-TOFMS. By considering the energy-dependent transmission of ions and the ion sampling efficiency together, the resultant mass bias is estimated. The mathematical description is developed for OA-TOFMS using different ionization sources and ion energy distributions, and several examples covering possible time-of-flight conditions and aspects of their application are considered.

Heterogeneity in small heat shock proteins (sHsps) spans multiple spatiotemporal regimes—from fast fluctuations of part of the protein, to conformational variability of tertiary structure, plasticity of the interfaces, and polydispersity of the inter-converting, and co-assembling oligomers. This heterogeneity and dynamic nature of sHsps has significantly hindered their structural characterization. Atomic coordinates are particularly lacking for vertebrate sHsps, where most available structures are of extensively truncated homomers. sHsps play important roles in maintaining protein levels in the cell and therefore in organismal health and disease. HspB2 and HspB3 are vertebrate sHsps that are found co-assembled in neuromuscular cells, and variants thereof are associated with disease. Here, we present the structure of human HspB2/B3, which crystallized as a hetero-tetramer in a 3:1 ratio. In the HspB2/B3 tetramer, the four α-crystallin domains (ACDs) assemble into a flattened tetrahedron which is pierced by two non-intersecting approximate dyads. Assembly is mediated by flexible “nuts and bolts” involving IXI/V motifs from terminal regions filling ACD pockets. Parts of the N-terminal region bind in an unfolded conformation into the anti-parallel shared ACD dimer grooves. Tracts of the terminal regions are not resolved, most likely due to their disorder in the crystal lattice. This first structure of a full-length human sHsp heteromer reveals the heterogeneous interactions of the terminal regions and suggests a plasticity that is important for the cytoprotective functions of sHsps., Graphical abstract Unlabelled Image, Highlights • Dynamic behavior of heteromeric sHsps hinders structural biology of cytoprotection. • Full-length human HspB2/B3 in 3:1 ratio was crystallized and solved at 3.9-Å resolution. • Assembly is by flexible “nuts and bolts” from terminal regions filling domain pockets. • N-terminal regions bind in an unfolded conformation into shared dimer grooves. • IXI/V motifs from unstructured proteins may be sequestered by sHsps during disease.

Indoor, intensive, nursery-based recirculating aquaculture systems (RAS) can provide high-quality juvenile shrimp for indoor or pond-based production systems in a biosecure manner. However, it is unclear what type of RAS is most appropriate for indoor shrimp nurseries. This study compared three types of RAS nurseries: biofloc (BF), clear-water (CW), and hybrid (HY). Each treatment included four, randomly assigned 160 L (0.35-m2) tanks that were stocked with 3000 post-larvae shrimp m−3. The post-larvae (PL10) shrimp had an initial average weight of 7 ± 0.0 mg and were grown for 48 days. The BF tanks included external settling chambers as the only filtration mechanism. The CW tanks had settling chambers, foam fractionators, and external biofilters to fully clarify the water and process nitrogenous waste. Hybrid tanks included settling chambers, and external biofilters to maintain some suspended solids along with external biofiltration. Overall, the CW treatment had significantly higher dissolved oxygen (DO) and pH levels than the BF and HY systems. The HY treatment had significantly higher DO than the BF treatment. Nitrite concentration was significantly higher in the HY treatment than the CW treatment. Turbidity in the BF treatment was significantly higher than the other treatments. On the final sample date, the BF treatment had significantly higher nitrite and nitrate concentrations than the other treatments. Differences between treatments in terms of shrimp survival, mean harvest weight, specific growth rate, and feed conversion ratio were not significant. The final weight of the shrimp at 48 days for the BF, CW, and HY were 670 mg, 640 mg, and 590 mg respectively. A stable isotope mixing model indicated that, in the BF treatment, 13% of the C and 34% of the N in harvested shrimp tissue may have originated from biofloc material, signifying some nutrient recycling. The nitrification process was more effective with the inclusion of an external biofilter. All three system types appear suitable for RAS shrimp nursery production although consideration should be given to water quality consistency and filtration costs.

Objective To compare oral voriconazole vs placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Design Non-prespecified, secondary case-control analysis from a multicenter, double-masked, randomized placebo-controlled clinical trial. Methods Study Participants : Patients with smear-positive filamentous fungal ulcers and visual acuity of 20/400 or worse who eventuated to therapeutic penetrating keratoplasty (TPK). Intervention : Study participants were randomized to oral voriconazole vs oral placebo; all received topical antifungal drops. Main Outcome Measures : TPK button culture positivity. Results A total of 95 of 194 (49.5%) study participants enrolled at Madurai, Coimbatore, or Pondicherry, India eventuated to TPK in an average of 20.9 days (standard deviation 15.2 days, range 2-71 days). TPK button cultures were available for 67 of 95 (71%) of the TPKs performed and were positive for filamentous fungus in 45 of 67 (67%) cases. For each 1-day increase in the time to TPK there was 0.94-fold decreased odds of fungal culture positivity (95% confidence interval [CI] 0.90–0.98, P = .005). Those randomized to oral voriconazole had 1.26-fold increased odds of TPK button culture positivity after controlling for time to TPK and baseline organism, but this was not statistically significant (95% CI 0.32–4.87; P = .74). Those who underwent TPK for lack of response to medical therapy were 10.64-fold more likely to be culture positive than if the indication for surgery was perforation and this was statistically significant (95% CI 2.16–51.70; P = .003). Conclusions There appears to be no benefit to adding oral voriconazole to topical antifungal agents in the treatment of severe filamentous fungal ulcers. Infection rather than inflammation appears to be the reason for the worsening clinical picture in many of these patients.

Indoor, recirculating aquaculture systems (RAS) can be used to nurse tilapia fry in a biosecure environment to support a variety of production systems; however, it is not understood what type of RAS may be most appropriate for this task. Clear-water and biofloc systems have advantages and disadvantages; hybrid systems combining positive features of both could optimize animal performance and minimize production costs. In this study, four replicate 160-L tanks were randomly assigned to clear-water (CW), biofloc (BF), or hybrid (HY) treatments. CW tanks had a settling chamber, foam fractionator, and external biofilter containing biomedia. BF tanks only had a settling chamber, and HY tanks used a settling chamber and external biofilter. Tilapia ( Oreochromis niloticus ) were stocked at 55 per tank (305 fish/m3) at 0.17 g average weight. Total Ammonia Nitrogen (TAN) and nitrate were not significantly different between systems. Nitrite was significantly higher in BF compared to CW and HY systems during the last 4 weeks of the study. Turbidity was significantly higher in BF systems versus other treatments. Tilapia in HY systems had significantly higher average weight and specific growth rate compared to BF. Tilapia in BF systems had significantly higher feed conversion ratios and significantly lower harvest biomass versus other treatments. Diminished performance in BF systems likely resulted from inferior water quality conditions. The results indicate that CW or HY systems may be a better choice for tilapia nurseries than chemoautotrophic BF systems due to the short term periods in which nurseries operate and the volitility of nitrification in biofloc systems.

Outcomes assessment of retreatment and endodontic microsurgery (EMS) are traditionally based on clinical findings and radiographs. The purpose of this study was to assess the volumetric change of periapical radiolucencies (PARLs) by cone-beam computed tomographic (CBCT)-based analysis in retreatment and EMS cases.For 68 retreatment and 57 EMS cases, preoperative and recall clinical data, periapical (PA) radiographs, and CBCT imaging were retrospectively obtained. Specialized software was used by 2 board-certified endodontists for volumetric analysis of PARLs. For EMS and retreatment, clinical outcomes were determined by combining clinical data with CBCT-generated volumetric analysis (PA radiographs not used). Additionally, comparisons of percent volume reduction for EMS and retreatment were performed. Examiner interpretations of outcomes assessment using PA radiography and CBCT imaging were compared.In teeth with or without a preoperative PARL, EMS resulted in a statistically significant difference in complete healing (49/57 [86.0%]) versus retreatment (28/68 [41.2%], P .0001). EMS resulted in a statistically significant difference in combined complete healing and reductive healing (54/57 [94.7%]) versus retreatment (56/68 [82.4%], P .05). Of 46 recalls in which CBCT imaging detected a PARL, PA radiography detected 30 (a 35% false-negative rate). Of the 79 recall studies in which CBCT imaging did not detect a PARL, PA radiography did detect PARL in 13 (a 16.5% false-positive rate).In this CBCT and clinical data-based outcomes assessment, EMS resulted in a greater mean volumetric reduction and a higher healing rate compared with retreatment. Postoperative CBCT imaging is more sensitive and specific than PA radiography in assessing PARL and has demonstrable usefulness in outcomes assessment.

Background This study examines the outcome of hybrid revascularization combining iliofemoral endarterectomy and iliac artery stenting using covered stents in TransAtlantic Inter-Society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD) involving the common femoral artery (CFA). Methods A retrospective review was conducted in patients with TASC C and D AIOD involving the CFA and undergoing hybrid revascularization. Covered stents were used primarily. Demographics, indications for surgery, lesion classification, hospital length of stay (LOS), 30-day morbidity/mortality, hemodynamic and clinical success, and patency were assessed. Results Thirty-six male patients (41 limbs), mean age 63.9 ± 6 years, were identified (TASC C = 39%, D = 61%). Indications for surgery were claudication (27%), rest pain (44%), and tissue loss (29%). A simultaneous adjunctive procedure (5 infrainguinal bypass, 3 superficial femoral artery stents) was performed in 22%. Thirty-day outcomes included 1 mortality (2.7%) and 2 reoperation (5.5%), 1 for femoral artery pseudoaneurysm and 1 for bilateral groin seroma. LOS was 4 days (interquartile range 3–6). All patients with available data experienced 30-day clinical and hemodynamic success. Mean follow-up was 23 months (range 1–79 months) with a primary patency of 85.4%. Cumulative primary assisted and secondary patency was 92.6%. The femoral patch repair was the most frequent site of reintervention (3/3). Mortality was 34% during the study period, and it was significantly higher in patients with tissue loss (57.1% vs. 14.8%, P = 0.01). Conclusions The hybrid approach has low morbidity, mortality, and fast recovery. The use of covered stents/stent grafts provides good mid-term patency. Close follow-up with noninvasive imaging is paramount to avoid repair failure, in particular at the femoral patch repair site.

Purpose To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from closer follow-up or more aggressive treatment. Design Secondary analysis of randomized clinical trial data. Methods We compared the clinical outcomes of patients who had positive 6-day fungal cultures with those who did not, using backward stepwise regression with covariates for all baseline clinical characteristics. Subjects : Patients presenting with a smear-positive filamentous fungal ulcer and visual acuity of 20/400 or worse, and who subsequently had a 6-day fungal culture performed at the Aravind Eye Care system (India), Lumbini Eye Hospital (Nepal), or Bharatpur Eye Hospital (Nepal). Main Outcome Measures : The primary outcome is rate of corneal perforation and/or the need for therapeutic penetrating keratoplasty. Secondary outcomes include 3-month best spectacle-corrected visual acuity (BSCVA), 3-month infiltrate and/or scar size, and rate of re-epithelialization. Results Patients who tested positive at their 6-day culture had twice the hazard of experiencing a corneal perforation or the need for therapeutic penetrating keratoplasty (P = .002) than those who tested negative, even after controlling for baseline ulcer characteristics. These patients also had on average 0.26 logMAR lines worse BSCVA at 3 months (P = .001). Culture positivity at day 6 was not a statistically significant predictor of 3-month infiltrate/scar-size (−0.24 mm1; P = .45) or time to re-epithelialization (hazard ratio = .81; P = .31). Conclusions Here we identify a uniquely valuable clinical tool, day 6 culture results, for the treatment of severe fungal keratitis. Risk stratification based on repeat culture positivity is an objective way to assess response to medical therapy and identify patients who are at high risk of a poor clinical outcome. This establishes a new standard of care for severe fungal keratitis management.

Objective A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review the international literature investigating the neurophysiologic changes in the soft palate and uvula that contribute to progression from snoring to OSA. Methods PubMed/MEDLINE and 4 other databases were systematically searched through July 4, 2017. Eligibility: (1) Patients: controls, snoring or OSA patients (2) Intervention: neuromuscular evaluation of the palate and/or uvula (3) Comparison: differences between controls, snoring and OSA patients (4) Outcomes: neuromuscular outcomes (5) Study design: Peer reviewed publications of any design. Results 845 studies were screened, 76 were downloaded in full text form and thirty-one studies met criteria. Histological studies of the soft palate demonstrated diffuse inflammatory changes, muscular changes consistent with neuropathy, and neural aberrancies. Sensory testing studies provided heterogeneous outcomes though the majority favored neuronal dysfunction. Studies have consistently demonstrated that increasing severity of snoring and sleep apnea is associated with worsening sensory nerve function of the palate in association with atrophic histological changes to the nerves and muscle fibers of the soft palate and uvula. Conclusions Recent evidence highlighted in this systematic review implicates the role of neurogenic pathology underlying the loss of soft palate and/or uvular tone in the progression of snoring to sleep apnea.

Prevention of tick-borne diseases requires an understanding of when and where exposure to ticks is most likely. We used an epidemiologic approach to define these parameters for residents of a Lyme-endemic region. Two persons in each of 500 Connecticut households were asked to complete a log each night for one week during June, 2013. Participants recorded their whereabouts in 15min increments (indoors, outdoors in their yard, outdoors on others' private property, or outdoors in public spaces) and noted each day whether they found a tick on themselves. Demographic and household information was also collected. Logs were completed for 934 participants in 471 households yielding 51,895 time-place observations. Median participant age was 49 years (range 2-91 years); 52% were female. Ninety-one participants (9.8%) reported finding a tick during the week, with slightly higher rates among females and minors. Household factors positively associated with finding a tick included having indoor/outdoor pets (odds ratio (OR)=1.7; 95% confidence interval (CI): 1.1-2.9), the presence of a bird feeder in the yard (OR=1.9; CI:1.2-3.2), and presence of an outdoor dining area (OR=2.2; CI:1.1-4.3). Individual factors associated with finding a tick on a given day were bathing or showering (OR=3.7; CI:1.3-10.3) and hours spent in one's own yard (OR=1.2, CI:1.1-1.3). Nineteen participants found ticks on multiple days, more than expected assuming independence (p0.001). Participants who found ticks on multiple days did not spend more time outdoors but were significantly more likely to be male than those finding ticks on a single day (p0.03). Our findings suggest that most tick exposures in the study area occurred on private property controlled by the respective homeowner. Interventions that target private yards are a logical focus for prevention efforts.

We report on conversion of energy released due to chemical reactions into current for the decomposition of aqueous hydrogen peroxide solution on single phases Pt and TiO 2 , in addition to Pt and TiO 2 simultaneously. We observe that H 2 O 2 decomposition-induced current on TiO 2 drastically overshadows the current generated by H 2 O 2 decomposition on Pt. Photo-effects avoided, H 2 O 2 decomposition was found to yield a conversion efficiency of 10 −3 electrons generated per H 2 O 2 molecule. Further understanding of chemical reaction-induced current shows promise as a metric with which the surface reaction may be monitored and could be greatly extended into the field of analytical chemistry.

In this work, we report the temperature-dependent transport and resistive switching behaviour of a promising hybrid structure made of La0.7Ca0.3MnO3 (LCMO) and reduced graphene oxide (rGO). The current-voltage (IV) characteristics are non-linear across the studied temperature range of 100 K–300 K, which is also temperature-dependent. The memristive effect is most prominent at 200 K, while the reduction of hysteresis in the IV-curve with decrease in temperature is ascribed to the low thermal energy of the charge carriers. The charge transport in the SET and RESET process at different temperatures can be explained using trap-controlled space charge limited conduction mechanism for temperature > 200 K and Poole-Frenkel emission at temperatures below that.

In this study, we reported the presence of robust, reversible unipolar electric pulse-induced resistance switching effects in copper iodide and La0.7Sr0.3MnO3 nanocomposites. The properties of the resistive switching and change in the I–V pattern was analyzed over 100 cycles by hysteretic pulse current–voltage measurement (pulse width = 0.01 s and pulse period = 0.02 s). The charge transport analysis of various regions of the 1st cycle pointed towards Schottky emission and Poole–Frenkel effect to be the dominant mechanisms in lower bias region and higher bias region respectively. On the other hand, resistive switching turned out to be stable over 1000 cycles of square electrical pulse train measurement where frequency of 125 Hz (pulse period 2 ms and pulse width 100 μ s ) and 250 Hz (pulse period 1 ms and pulse width 50 μ s ) were used.

A solution-cathode glow discharge (SCGD) using a novel rectangular-shaped cathode capillary is used to study aspects of the plasma-liquid interface. High-speed video of the plasma-liquid interface captured simultaneously with low-angle laser scattering from droplets near the plasma-liquid interface are studied in concert to evaluate potential mechanisms related to surface-plasma interaction. Frame-by-frame analysis of high-speed video allows estimation of droplet number density, translational speed, and rate of ejection. The data are evaluated to provide insight into potential mechanisms of analyte transport that are of importance for the use of SCGD in analytical atomic spectrometry.

With the recent surge of emerging memory technologies, the demand for storage capacities in various applications is more than ever. Oxide material based memory elements are promising candidates for designing future non-volatile storage architectures. In this work, we investigated the structural, transport and resistive switching (RS) behaviour of a novel hybrid structure made of calcium doped LaMnO3 (LCMO) and reduced graphene oxide (rGO). Very stable and robust bipolar RS behaviour was observed with additional tunability obtained through the variation in the rGO concentration in the structure. The presence of a metal to insulator transition is clearly observed with a lowering of the transition temperature on increase in the rGO content. Both the effects can be attributed to the oxygen vacancy generation and filament formation as confirmed from the X-ray photoelectron spectroscopy (XPS) and high resolution transmission electron microscopy (HRTEM) measurements. The combined attributes of easy fabrication route, robust switching behaviour and environmental stability of the present system makes it a superior candidate for future non-volatile memory design and oxide electronics.

Neurodegeneration leads to redistribution of processing, which is reflected in a reorganisation of the structural connectome. This might affect its vulnerability to structural damage. Cortical acetylcholine allows favourable adaptation to pathology within the memory circuit. However, it remains unclear if it acts on a broader scale, affecting reconfiguration of whole-brain networks. To investigate the role of the cholinergic basal forebrain (CBFB) in strategic lesions, twenty patients with mild cognitive impairment (MCI) and twenty elderly controls underwent magnetic resonance imaging. Whole-brain tractograms were represented as network graphs. Lesions of individual nodes were simulated by removing a node and its connections from the graph. The impact of simulated lesions was quantified as the proportional change in global efficiency. Relationships between subregional CBFB volumes, global efficiency of intact connectomes and impacts of individual simulated lesions of network nodes were assessed. In MCI but not controls, larger CBFB volumes were associated with efficient network topology and reduced impact of hippocampal, thalamic and entorhinal lesions, indicating a protective effect against the global impact of simulated strategic lesions. This suggests that the cholinergic system shapes the configuration of the connectome, thereby reducing the impact of localised damage in MCI.

Deamidation of Glu147 in human αA-crystallin is common in aged cataractous lenses (Hains and Truscott, Invest. Ophthalmol. Vis. Sci. 2010, 51, 3107). Accordingly, this modification may have a causative effect in cataract. αA-crystallin is a small heat-shock molecular chaperone protein that prevents aggregation of proteins and is the principal defence against crystallin unfolding and aggregation in the ageing lens. Deamidated Q147E αA-crystallin was structurally characterised using a variety of spectroscopic and biophysical methods, including NMR, circular dichroism and fluorescence spectroscopy and dynamic light scattering. The effect of Glu147 deamidation on αA-crystallin in vitro chaperone ability was determined for a variety of aggregating proteins. Compared to the wild type protein, Q147E αA-crystallin generally exhibited slightly reduced chaperone ability and a small loss of overall structure in its central α-crystallin domain while also showing significantly enhanced thermal stability and a tendency to form slightly larger oligomers. As αA-crystallin is the major lens protein, even a small loss of function could combine with other sources of age-related damage to the crystallins to contribute to lens opacification.

Minimal-exchange, intensive biofloc aquaculture systems offer a viable means of culturing marine animals at inland locations due to very low rates of water use. Fresh, never-frozen shrimp can be provided to metropolitan markets; however, the cost of artificial salt can be substantial. The purpose of this project was to examine commercial-scale biofloc shrimp production at three different salinities. Nine raceways were randomly assigned to three salinity treatments: 10, 20, and 30‰ (LS, MS, and HS), each treatment contained three raceways operated at 50 m 3 . The raceways were operated as heterotrophic biofloc systems, with daily additions of sucrose to raise the C:N ratio. Temperature, dissolved oxygen, pH, and salinity were all maintained at consistent levels. Spikes of ammonia and nitrite occurred in all tanks but nitrate remained low, with a peak value of 8.7 mg NO 3 -N L − 1 . There were no significant differences in any shrimp production metric. Mean shrimp growth rate was 1.8, 2.0, and 2.0 g week − 1 in the LS, MS, and HS treatments respectively. Mean feed conversion rate was 1.6, 1.2, and 1.2 in the LS, MS, and HS treatments respectively, and mean final weight ranged from 17.8 to 19.3 g. The only time water was removed from the systems was when settling chambers were emptied, resulting in a total mean water replacement of 5.2% or less per raceway. The mean volume of full strength seawater used to produce shrimp was 104, 159, and 235 L kg − 1 of shrimp in the LS, MS, and HS treatments respectively. Although there were no significant differences in shrimp production metrics between treatments, these values were noticeably lower in the LS treatment due to human error. Operating at the low salinity of 10‰ reduces salt use by about 50% over the MS treatment which implies substantial cost savings for production facilities. This study helps to illustrate the range of salinity options for shrimp production in commercial-scale biofloc systems.

To determine whether patients who had a positive repeated culture was predictive of worse clinical outcome than those who achieved microbiological cure at 6 days in the Mycotic Ulcer Treatment Trial I (MUTT-I).Secondary analysis from a multicenter, double-masked, randomized clinical trial.setting: Multiple hospital sites of the Aravind Eye Care System, India.Patients with culture-positive filamentous fungal ulcers and visual acuity of 20/40 to 20/400 reexamined 6 days after initiation of treatment.Corneal scraping and cultures were obtained from study participants at day 6 after enrollment.We assessed 3-month best spectacle-corrected visual acuity (BSCVA), 3-month infiltrate/scar size, corneal perforation, and re-epithelialization rates stratified by culture positivity at day 6.Of the 323 patients with smear-positive ulcers enrolled in MUTT-I, 299 (92.6%) were scraped and cultured 6 days after enrollment. Repeat culture positivity was 31% (92/299). Among patients who tested positive at enrollment, those with positive 6-day cultures had significantly worse 3-month BSCVA (0.39 logMAR; 95% confidence interval [CI]: 0.24-0.44; P.001), had larger 3-month scar size (0.39 mm; 95% CI: 0.06-0.73; P = .02), were more likely to perforate or require therapeutic penetrating keratoplasty (odds ratio: 6.27; 95% CI: 2.73-14.40; P.001), and were slower to re-epithelialize (hazard ratio: 0.33; 95% CI: 0.21-0.50; P.001) than those with a negative 6-day culture result.Early microbiological cure on culture is a predictor of clinical response to treatment.

Indoor shrimp aquaculture systems can be used to produce fresh, never-frozen, quality shrimp near metropolitan seafood markets regardless of season and climate. However, questions still remain regarding what type of production system is best suited to maximize indoor production. In this project, two types of systems were compared: clear-water (CW) RAS and biofloc (BF) systems. Three, 1.36 m3 tanks were assigned to each of the two treatments; CW tanks had external settling chambers, two foam fractionators, and external biofilters, all operated continuously. BF tanks had settling chambers and one foam fractionator which were operated as needed to control solids accumulation. Shrimp weighing 0.42 g were stocked in all tanks at 250 m−3 and grown for 55 days. Ammonia and pH levels were significantly (P

The objective of this study was to re-evaluate and simplify the Greenfield risk assessment profile (RAP) for venous thromboembolism (VTE) in trauma using information readily available at the bedside.Retrospective review of 1233 consecutive admissions to the trauma intensive care unit from August 2011-January 2015. Univariate analyses were performed to determine which RAP risk factors were significant contributors to VTE. Multivariable logistic regression was used to develop models for risk stratification. All results were considered statistically significant at P ≤ 0.05.The study population was as follows: age 44 ± 19, 75% male, 72% blunt, injury severity score 21 ± 13, RAP score 9 ± 5, and 8% mortality. Groups were separated into +VTE (n = 104) and -VTE (n = 1129). They were similar in age, gender, mechanism, and mortality, but injury severity and RAP scores were higher in the +VTE group (all P 0.0001). The +VTE group had more transfusions and longer time to prophylaxis (all P 0.05). Receiving four or more transfusions in the first 24 h (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.64-4.13), Glasgow coma score8 for4 h (OR, 2.13; 95% CI, 1.28-3.54), pelvic fracture (OR, 2.26; 95% CI, 1.44-3.57), age 40-59 y (OR, 1.70; 95% CI, 1.10-2.63), and2-h operation (OR, 1.80; 95% CI, 1.14-2.85) predicted VTE with an area under the receiver operator curve of 0.729, which was comparable with 0.740 for the RAP score alone.VTE risk in trauma can be easily assessed using only five risk factors, which are all readily available at the bedside (transfusion, Glasgow coma scale, pelvic fracture, prolonged operation, and age). This simplified model provides similar predictive ability to the more complicated RAP score. Prospective validation of a simplified risk assessment score is warranted.

Conventional glow discharge emission or mass spectrometry requires the assumption that the surface of the sample is homogeneous. However, recent developments in glow discharge imaging appear to offer an opportunity to obtain three-dimensional concentration maps, in which this assumption is no longer necessary. Here, experiments, models, and a summary of earlier work are combined to examine the sputtering behavior of elemental and morphological heterogeneities in a sample. The theoretical model reveals gaps in current knowledge of glow discharge sputtering of heterogeneous samples, particularly indicating that heterogeneity in the sample leads to roughened crater bottoms and how additional morphology can evolve. Additionally, a three-dimensional profiling microscope is used to characterize the effects of surface inclusions on the sputtering process in a DC glow discharge in a reduced-pressure argon environment. Findings have important implications for bulk analysis, depth-profiling, and elemental surface mapping with glow discharge spectrometry.

A digital micromirror array (DMMA) is used in a simple and inexpensive approach for spatially resolved temporal gating of atomic emission detection in laser-induced breakdown spectroscopy (LIBS). Selected mirrors in the array are actuated at a time delayed from the primary laser pulse, permitting optical gating with a response time of 160 ns while using a conventional CCD detector. Detector gating is shown to decrease noise from short-lived spectroscopic background (both continuum and N II from air), improving signal-to-background ratios by 22-times for selected samples and emission lines. The utility of rapid temporal gating is also demonstrated for the optical detection of isotopes using the laser-ablation molecular isotope spectrometry (LAMIS) experiment. Optical temporal gating and spatial filtering are used to isolate regions of the laser-induced plasma, enhancing signal from molecular emission. The potential of the simple technique for use in field-portable LIBS and LAMIS experiments is explored.