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Objectives To determine whether altered mental status (AMS) as a presenting symptom in older adults with COVID-19 is independently associated with adverse outcomes. Methods A retrospective single center observational study of admitted patients (n = 421) age greater than 60 and a positive COVID-19 test. Outcomes included mortality, intubation, acute respiratory distress syndrome, acute kidney injury, and acute cardiac injury. Multivariate regression analysis was used to determine if presenting with AMS was associated with adverse outcomes. Results There was an increased risk of mortality (RR 1.29, 95% CI 1.05–1.57), intubation (RR 1.52, 95% CI 1.09–2.12) and AKI (RR 1.42, 95% CI 1.13–1.78) in patients that presented with AMS. Conclusions During a global pandemic, prognostic indicators are vital to help guide the clinical course of patients, reduce healthcare cost, and preserve life. Our study suggests that AMS can play a major role in diagnostic algorithms in older adults with COVID-19.

Aims To investigate factors that contribute to patient decisions regarding attendance for arthroplasty during the COVID-19 pandemic. Methods A postal questionnaire was distributed to patients on the waiting list for hip or knee arthroplasty in a single tertiary centre within the UK. Patient factors that may have influenced the decision to attend for arthroplasty, global quality of life (QoL) (EuroQol five-dimension three-level (EQ-5D-3L)), and joint-specific QoL (Oxford Hip or Knee Score) were assessed. Patients were asked at which ‘COVID-alert’ level they would be willing to attend an NHS and a “COVID-light” hospital for arthroplasty. Independent predictors were assessed using multivariate logistic regression. Results Of 540 distributed questionnaires, 400 (74.1%; 236 awaiting hip arthroplasty, 164 awaiting knee arthroplasty) complete responses were received and included. Less than half (48.2%) were willing to attend for hip or knee arthroplasty while a UK COVID-19 epidemic was in circulation (COVID-alert levels 3 to 5). Patients with worse joint-specific QoL had a preference to proceed with surgery at COVID-alert levels 3 to 5 compared to levels 1 and 2 (hip arthroplasty odds ratio (OR) 1.54 (95% confidence interval (CI) 1.45 to 1.63); knee arthroplasty OR 1.16 (1.07 to 1.26)). The odds of patients with worse joint-specific QoL being willing to attend for surgery at COVID-alert levels 3 to 5 increased further if surgery in a private, “COVID-light” hospital was available (hip arthroplasty OR 3.50 (95% CI 3.26 to 3.71); knee arthroplasty OR 1.41 (95% CI 1.29 to 1.53). Conclusion Patient decisions surrounding elective surgery have been influenced by the global COVID-19 pandemic, highlighting the importance of patient involvement in ensuring optimized provision of elective surgery during these challenging times. Cite this article: Bone Jt Open 2021;2(4):261–270.

Morning coffee is a common remedy following disrupted sleep, yet each factor can independently impair glucose tolerance and insulin sensitivity in healthy adults. Remarkably, the combined effects of sleep fragmentation and coffee on glucose control upon waking per se have never been investigated. In a randomised crossover design, twenty-nine adults (mean age: 21 (sd 1) years, BMI: 24·4 (sd 3·3) kg/m2) underwent three oral glucose tolerance tests (OGTT). One following a habitual night of sleep (Control; in bed, lights-off trying to sleep approximately 23.00–07.00 hours), the others following a night of sleep fragmentation (as Control but waking hourly for 5 min), with and without morning coffee approximately 1 h after waking (approximately 300 mg caffeine as black coffee 30 min prior to OGTT). Individualised peak plasma glucose and insulin concentrations were unaffected by sleep quality but were higher following coffee consumption (mean (normalised CI) for Control, Fragmented and Fragmented + Coffee, respectively; glucose: 8·20 (normalised CI 7·93, 8·47) mmol/l v. 8·23 (normalised CI 7·96, 8·50) mmol/l v. 8·96 (normalised CI 8·70, 9·22) mmol/l; insulin: 265 (normalised CI 247, 283) pmol/l; and 235 (normalised CI 218, 253) pmol/l; and 310 (normalised CI 284, 337) pmol/l). Likewise, incremental AUC for plasma glucose was higher in the Fragmented + Coffee trial compared with Fragmented. Whilst sleep fragmentation did not alter glycaemic or insulinaemic responses to morning glucose ingestion, if a strong caffeinated coffee is consumed, then a reduction in glucose tolerance can be expected.

The 2nd annual Health Equity Summer Research Summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM), was a forum to catalyze the fertilization and exchange of cutting-edge ideas in the area of disparity research in medicine. The summit fosters understanding of current health equity research, training, clinical care, and outreach initiatives, in addition to offering an opportunity for connecting with allies and partners working in the field of health equity and health disparities. The summit provides opportunities for our COE Scholars (undergraduate/post-baccalaureate students and Baylor medical students, clinical fellows and junior faculty) to showcase their research findings which are reflective of their past year's endeavor as scholars at the center. Abstracts in this Book of Abstracts represent a summary of these research efforts. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health.

Visually impaired people find it difficult to live without support from other people; they need support even for their basic needs like food preparation, identifying different objects, etc. Our mobile application system developed using technologies like IoT and deep learning can decrease their difficulties to a certain extent. The primary feature is to detect the content present in a particular container; people with visual impairments find it difficult to recognize the items present in a container. With the implementation of the system, it makes it seamlessly easy for visually impaired people to recognize contents of a container by a sense of touch. Object detection is used to detect nearby objects in real time. An Iris assistive feature is also included in our app to provide guidance to the visually impaired people by our sighted volunteers in a group chat manner. Our app is designed in a manner so that both common people and visually challenged people can utilize our application for comfortable cuisine preparation and grocery shopping. At the latter, there is an LPG leak detection mechanism to automatically shut off gas in case of accidental leaks. Our project mainly aims at bringing a blind-friendly kitchen environment.

When considering repair of the meniscal cartilages of the knee, the indications for repair must be carefully considered. The morphology of the tear, the zone of injury, and likely vascularity have an impact on patient selection. Patient factors, chronicity of tear, medial or lateral tear, and tear complexity all have a bearing on whether to repair or resect and how best to achieve stable repair. The consequences of meniscectomy are well established, and meniscal tissue resection comes at a cost. The success rates of meniscal cartilage repair are greater when performed in conjunction with anterior cruciate ligament reconstruction. Patient outcomes are better for anterior cruciate ligament reconstruction when performed with meniscal repair than when partial meniscectomy is performed. The optimal configuration of sutures, the suture material used, and the type of suture technique are all important considerations. The focus of this commentary is on the use of absorbable versus nonabsorbable suture material.

Purpose: Reddit is a social media platform that allows health care professionals (HPs) to anonymously interact with patients. We analyzed content about radiation therapy (RT) on Reddit. Methods and Materials: Reddit.com/r/cancer was queried with 20 search terms related to RT: IMRT, 3D-CRT, SBRT, EBRT, XRT, radiation, radiotherapy, RT, radio, rad, rads, gamma, gamma knife, gammaknife, cyber knife, cyberknife, cyber, brachytherapy, brachy, and cobalt. The search aimed to identify all posts discussing RT. A random sample of posts and their top 3 comments was selected to generate qualitative thematic codes per author consensus, which were used to characterize all posts and their top 3 voted comments. Posts were analyzed for time to first reply, mention of any specific RT modality, whether a self-identified HP responded, and time to first highly voted comment by an HP. Results: Exactly 190 posts about RT by 178 users were shared from February 2011 to May 2018, and 468 replies by 295 users were also analyzed. Twenty-nine of these users (9.8%) were HPs; however, 48 of 181 top comments were contributed by HPs compared with 45 of 288 non–top comments by HPs (odds ratio, 1.95; 95% confidence interval [CI], 1.23-3.08; P

Automation is the next revolution that will affect every industry in some way or other in this century. The shift from hunting to farming is regarded as one of the most significant steps in the evolution of human species. There has been large number of advancements in the agricultural sector over many millennia; from using sticks to create holes in the soil to using advanced robots to plant seeds, humans have come a long way. Automation in farming sector, especially in developing countries, is currently a less accepted and applied concept. The present work focuses on developing an Automated Seed Sowing Robot (ASSR) that will reduce human intervention and fatigue, while reducing current investment costs. The characteristic tasks performed by this ASSR are shearing a plot of well ploughed land, controlled and timed seed sowing in the created separation, and covering the soil. The design can perform efficiently on actual farmlands. The targeted crops include legumes like soybean and peas. Electrical energy, required for running the various mechanical components like motors and sensors of the system, is supplied with the help of rechargeable batteries. The robot can traverse the field by itself using a closed loop system relying on digital encoders among other sensors which are controlled by a microcontroller. Thus, the present work involves the efficient designing and fabrication of ASSR and the successful testing of the same.

When creating art, the mind becomes free of physical barriers, no longer feeling broken or different. These same results can be sustained long term over large populations of survivors of traumatic events by grouping individuals into teams to create art of all types with the focus being on helping others. Long-term sustainability can occur with the concept of dedicated centers such as art studios and performing art centers with others that believe in art's healing potential. The simple activity of healing yourself while helping others heal, in whatever large or small way, can help us thrive beyond just surviving. No matter how long ago a traumatic event occurred in someone's life, those lessons learned should be shared with new burn survivors as they go through the long and difficult healing process by having a place that they can go and be with others who have been through the same process.

Purpose To examine the influence of post-exercise protein feeding upon the adaptive response to endurance exercise training. Methods In a randomised parallel group design, 25 healthy men and women completed 6 weeks of endurance exercise training by running on a treadmill for 30–60 min at 70–75% maximal oxygen uptake (VO2max) 4 times/week. Participants ingested 1.6 g per kilogram of body mass (g kg BM−1) of carbohydrate (CHO) or an isocaloric carbohydrate–protein solution (CHO-P; 0.8 g carbohydrate kg BM−1 + 0.8 g protein kg BM−1) immediately and 1 h post-exercise. Expired gas, blood and muscle biopsy samples were taken at baseline and follow-up. Results Exercise training improved VO2max in both groups (p ≤ 0.001), but this increment was not different between groups either in absolute terms or relative to body mass (0.2 ± 0.2 L min−1 and 3.0 ± 2 mL kg−1 min−1, respectively). No change occurred in plasma albumin concentration from baseline to follow-up with CHO-P (4.18 ± 0.18 to 4.23 ± 0.17 g dL−1) or CHO (4.17 ± 0.17 to 4.12 ± 0.22 g dL−1; interaction: p > 0.05). Mechanistic target of rapamycin (mTOR) gene expression was up-regulated in CHO-P (+ 46%; p = 0.025) relative to CHO (+ 4%) following exercise training. Conclusion Post-exercise protein supplementation up-regulated the expression of mTOR in skeletal muscle over 6 weeks of endurance exercise training. However, the magnitude of improvement in VO2max was similar between groups.

Purpose The American College of Surgeons Oncology Group trial Z0011 demonstrated that axillary node dissection (ALND) can be omitted in patients managed with breast conserving surgery and 1 to 2 positive sentinel lymph nodes (SLNs) without adverse effects on locoregional recurrence or disease-free survival (DFS). We investigated patients with breast cancer for whom clinicopathologic features were underrepresented in the Z0011 trial and analyzed radiation therapy treatment patterns and clinical outcomes. Methods and materials We retrospectively reviewed records of patients who underwent a lumpectomy and SLN biopsy with positive SLNs but not an ALND and completed adjuvant radiation therapy. Eligible patients had T3 tumors, >2 positive SLNs, invasive lobular carcinoma, estrogen receptor negative status, extranodal extension, Nottingham Grade 3, or were age Results We identified 105 women treated between July 2011 and July 2016 with a median follow-up time of 48.5 months (Range, 11-83 months). There were 40 women with an extranodal extension (38.9%) and 42 women with grade 3 disease (40.0%). Nineteen patients received whole breast irradiation alone (18.1%) and 86 patients were treated with modified tangent fields including the superior axilla level I/II (81.9%). Thirty-three patients (31.4%) also received a 3rd supraclavicular, nodal-directed field. Among the 86 patients who received axillary nodal irradiation, nodal volume contouring was performed in 77 patients (89.5%). Fifty-one patients (48.6%) also received adjuvant chemotherapy. The overall rates of 4-year DFS and locoregional control (LRC) were 94.3% and 98.1%, respectively. Off all patients, 1 patient experienced an internal mammary nodal recurrence, another patient a contralateral breast tumor, and two patients distant metastases. There were no axillary or ipsilateral breast tumor recurrences. Conclusions This retrospective analysis of women who were underrepresented or excluded from the Z11 trial and underwent a lumpectomy and SLN biopsy with positive SLNs demonstrated comparable rates of LRC and DFS. The high rates of LRC and DFS suggest that completion ALND may be safely omitted in this patient population but larger data sets and longer follow-up times are needed to confirm this finding.

The timing of carbohydrate ingestion and how this influences net muscle glycogen utilization and fatigue has only been investigated in prolonged cycling. Past findings may not translate to running because each exercise mode is distinct both in the metabolic response to carbohydrate ingestion and in the practicalities of carbohydrate ingestion. To this end, a randomized, cross-over design was employed to contrast ingestion of the same sucrose dose either at frequent intervals (15 × 5 g every 5 min) or at a late bolus (1 × 75 g after 75 min) during prolonged treadmill running to exhaustion in six well-trained runners ( 61 ± 4 ml·kg−1·min−1). The muscle glycogen utilization rate was lower in every participant over the first 75 min of running (Δ 0.51 mmol·kg dm−1·min−1; 95% confidence interval [−0.02, 1.04] mmol·kg dm−1·min−1) and, subsequently, all were able to run for longer when carbohydrate had been ingested frequently from the start of exercise compared with when carbohydrate was ingested as a single bolus toward the end of exercise (105.6 ± 3.0 vs. 96.4 ± 5.0 min, respectively; Δ 9.3 min, 95% confidence interval [2.8, 15.8] min). A moderate positive correlation was apparent between the magnitude of glycogen sparing over the first 75 min and the improvement in running capacity (r = .58), with no significant difference in muscle glycogen concentrations at the point of exhaustion. This study indicates that failure to ingest carbohydrates from the outset of prolonged running increases reliance on limited endogenous muscle glycogen stores—the ergolytic effects of which cannot be rectified by subsequent carbohydrate ingestion late in exercise.

Background Studies demonstrate safety of omitting axillary nodal dissection for early-stage breast cancer with positive sentinel lymph node (+SLN) biopsy, although trial designs differed in radiation therapy (RT) fields. Regional nodal irradiation was separately shown to improve outcomes in high-risk patients. This led to lack of consensus in RT volumes. Clinical pathways (CPs) standardize care where practice varies unnecessarily. We evaluated the impact of changes to a CP guiding postoperative RT in women with +SLNs on practice patterns throughout a network. Methods and materials We implemented a CP for management of breast cancer with postoperative RT designed to promote uniform nodal treatment. The CP recommended modified tangents (MTs) including level I/II nodes for women with micrometastases (pN1mi). For women with macrometastases (pN1a), CPs recommended including level I/II LN in MT and a third supraclavicular node (SCN) LN ± internal mammary nodes for women with adverse factors present. Results RT fields of 233 women undergoing breast-conserving surgery with +SLN but not axillary nodal dissection were retrospectively reviewed: 25% had pN1mi disease and 75% pN1a. Of 127 women treated before CP changes, 35% with pN1mi and 22% with pN1a were treated with whole-breast irradiation alone. Following CP changes, 106 women were treated: 5% with whole-breast irradiation alone, 58% with MT, and 38% with MT + SCN field. Utilization of MT was associated with CP changes. Utilization of a third SCN field was associated with CP changes, pN stage, extracapsular extension, and total number of adverse factors. Conclusions CPs translate published data and institutional experience into management plans that promote evidence-based care and eliminate unnecessary practice variations. Recognizing that postoperative RT treatment volumes were heterogeneous, we modified the CP based upon the latest evidence for regional nodal irradiation, after which we found increased compliance and consistency with quality guidelines, which will also aid in tracking outcomes in future investigations.

Background In orthopedic and sports medicine literature there is minimal information regarding accurate diagnosis and the treatment options for tenosynovitis of the distal semimembranosus tendon. After reviewing the literature, the authors question both the etiology and treatment of this condition. Previous descriptions have associated the condition primarily with the endurance athlete but we have noted multiple cases in which this is a condition common to the ‘sprinter' as well. There has been very little mention of this condition in recent literature but the most recent complete description of operative treatment for this condition recommends both tendon transfer and concomitant arthroscopy. We propose this condition is akin to De Quervain's tenosynovitis of the knee, with sensitive and specific signs on physical examination. Methods We describe a case series of six cases (five patients), that underwent open surgical release for semimembranosus tenosynovitis. The anatomy and the treatment options for the condition are also discussed. Results At a follow-up period of 18–64months, all cases showed improvement in the Tegner activity score following surgical release. Conclusion Diagnostic confusion can be decreased with more modern diagnostic imaging modalities than those described in the literature. The authors outline an alternative operative approach significantly decreasing surgical complexity and therefore post-operative morbidity. What is known about this subject: This is a rare condition and the surgical treatment is seldom performed. What this study adds to existing knowledge: We describe the technique for surgical decompression and reveal positive results at medium term follow-up.

Natural rubber latex (NRL) is present within many dental products including local anaesthetic (LA) cartridges. Patients with NRL sensitivity are at risk of developing type I and type IV allergic reactions from exposure to these products. Evidence from current literature is inconclusive yet highly suggestive that NRL contamination may occur in medicines stored within vials containing natural rubber components. It would therefore be prudent to avoid using such products in patients with a known NRL allergy. For dental practitioners this applies to LA cartridges and is easily achievable, as manufacturers now produce products not made with NRL. This article aims to provide guidance for dental health professionals regarding the use of LA in patients with a known NRL hypersensitivity. CPD/Clinical Relevance: NRL allergies are a rising concern amongst medical professions and these reactions should be avoided wherever possible.

Objectives: Long-term quality-of-life data following stereotactic body radiation therapy (SBRT) for recurrent head and neck cancer (rHNC) is underreported. We report patient-reported quality-of-life (PR-QOL) after at least 1 year post-treatment.Methods and Materials: A retrospective review was performed on 64 patients receiving SBRT for previously-irradiated rHNC. PR-QOL was prospectively evaluated using the University of Washington Quality of Life Questionnaire. The mixed effects proportional odds model was used to assess post-treatment overall PR-QOL changes, as well as the effects of late toxicities, tumor volume > 25 cc, local failure, nodal recurrence, distant failure, prior neck dissection, performance status other than ECOG 0 or Karnofsky 100, sex, age >65, squamous vs. non-squamous primary histology, and specific organ recurrence.Results: SBRT had no significant effect on overall PR-QOL at days 1-90 post-treatment (SBRT effect 0.035, p = 0.93) and days 91–365 (SBRT effect −0.30, p = 0.45). Beyond day 365, overall PR-QOL was significantly worse than baseline (SBRT effect −0.77, p =.03). Grade ≥3 late toxicities (p = 0.0072) and tumor volume > 25 cc (p = 0.032) predicted significantly worse overall PR-QOL. Oral cavity recurrence predicted significant decrements in chewing (p = 0.0006), swallowing (p = 0.0301), and taste PR-QOL (p = 0.02). Nasal recurrence predicted significant decrements in taste PR-QOL (p = 0.030). Grade ≥3 late dysphagia predicted significant decline in chewing (p = 0.039) and swallowing (p = 0.0004). Grade ≥3 late osteonecrosis predicted significant differences in pain PR-QOL (p = 0.0026).Conclusion: PR-QOL across several domains declines immediately after SBRT for previously-irradiated rHNC before returning to baseline levels at 1 year. Long-term PR-QOL declines thereafter. Patients with grade ≥3 late toxicities or tumor volume >25 cc report reduced long-term overall PR-QOL, likely representing late disease progression. Specific organ recurrence and grade ≥3 late toxicities predict decrements in specific PR-QOL domains.

Purpose Many patients with endometrial cancer cannot undergo surgery and instead receive definitive radiation therapy (RT). We investigate the correlation between MRI response to RT and clinical outcomes. Methods and Materials Women with inoperable, clinical Stage I endometrial cancer were treated with definitive brachytherapy (BT) with/without pelvic RT (PRT). Patients underwent MRI with functional diffusion-weighted imaging before and after RT. A radiologist retrospectively classified cases as complete, partial, or indeterminate response (CR, PR, or IR, respectively) vs. disease progression. Local control was clinicopathologically defined. Results From 2007 to 2017, 50 women underwent definitive RT. Thirty-five (70%) received BT alone (median dose 37.5 Gy). For combined therapy, the median PRT and BT doses were 45 and 25 Gy, respectively. Median gross tumor volume and high-risk clinical target volume were 7.1 cc and 90.0 cc, respectively. Median followup among living patients was 20 months. All patients underwent post-RT MRI with T1/T2 sequencing at a median of 3.2 months after RT; 40 patients (80%) underwent functional diffusion-weighted imaging sequences. On initial post-RT MRI, CR was documented in 42 patients (84%), IR in 1 patient (2%), and PR in seven patients (14%). At median followup of 16.3 months, no CR patients had uterine failure. Among eight patients with initial PR/IR, all were found to be clinicopathologically no evidence of disease at the uterus on further evaluation. Conclusions Definitive RT with BT or BT + PRT is associated with high response rates on MRI. Overall, initial CR predicted for excellent outcome with no infield failure.

In this project we are proposing a system which helps to improve the efficiency of Solar PV based agricultural water pump using thermal heat exchanger. We tried to reduce the temperature of the PV panel using thermal heat exchanger and we also installed an IDBB converter. In this way we can increase the voltage and efficiency of the system. Predominant elements of the framework, for example, the impact of sun powered radiation on engine force, ebb and flow, and water release are thought of. The proposed water system technique is more precise and proficient than the regular water system strategies as far as the measure of the water utilized for water system, and the exactness of flooding times dependent on changing neighborhood atmosphere.

Systematic analysis of integral aspects within sport enables improvement in performance. One key aspect is the management and prevention of injuries. Bibliometrics is a systematic method for evaluating research output. It may be expected that the quantity and quality of sports injury research over time may strongly correlate with the timing of the Olympic games. This study was conducted to determine the effect of the Olympic legacy on academic sports medicine and evidence to prevent injuries of the face and teeth. A literature search within the PubMed database was undertaken to identify the quantity of literature published annually between 1996 and 2015 in the fields of sports injuries and injury prevention. The top 5 journals publishing in each field were then identified and the change in their impact factor (IF) was investigated. It was seen that, since 1996, there has been an overall increase in the quantity of literature published regarding sports injuries and prevention of sports injuries of 209% and 217%, respectively. Publications regarding facial injuries and dental injuries within sport show an increase of 114% and 71%, respectively. There was an increase in IF since 2000 in almost every journal investigated. A strong, positive correlation is seen among journals publishing on the prevention of sports injuries, showing a median IF increase of 2.8198. No statistical significance was found between Olympic years and the number of publications. Hence, there has been a gradual increase in both the quality and quantity of publications regarding sports injuries since 1996. However, there appears to be no immediate added effect of the “Olympic legacy” following each Olympic games on the quantity or quality of publications in these fields.

Purpose Twitter may reflect attitudes underrepresented in traditional surveys. This study aimed to understand professionals' and patients’ thoughts regarding brachytherapy on Twitter. Methods and Materials Twitter was queried with “brachytherapy” to identify all tweets about patients' experiences from January 2012 to May 2017. A random sample of tweets by health care professionals containing “brachytherapy” was obtained using the first weekly tweet in the same interval. Consensus coding was used to categorize tweets as “patient” or “professional” based on content about receiving brachytherapy or self-identification as a health care professional. Tweets were analyzed for positive, neutral, or negative sentiment and recurrent themes using manual, iterative coding. Patient tweets were analyzed for whether they were shared before or after treatment and whether the patient, friends, or family had posted them. Professional tweets were analyzed to identify temporal theme changes. Results One hundred sixty-two patient tweets and 260 professional tweets were obtained from January 2012 to May 2017. On average, 2.5 patient tweets were shared monthly compared to 69 for providers. Among tweets by patients and professionals, 57% vs. 12% expressed positive sentiment, 21% vs. 3% negative sentiment, and 22% vs. 85% neutral sentiment, respectively. The most common patient and professional codes were “general sharing of experience/casual conversation” (32%) and “science” (21%), respectively. Conclusions Patients tweeted less about brachytherapy than professionals and generally expressed favorable and negative sentiments regarding their radiation treatment experiences. Professionals tended to express neutral sentiment and focus on research. Opportunities exist for greater radiation oncologist engagement in this medium.

This paper presents findings from a performance evaluation of laboratories in Kenya supported under the East Africa Public Health Laboratory Networking Project (EAPHLNP). The aim of the evaluation was to document progress and lessons learned, to enhance performance and foster sustainability.

During a large-scale “Black Sky” power outage in the continental United States, the private sector as well as federal, state, local, tribal, and territorial emergency management communities will be tasked with providing support for an extended period of time to a very large population over a large geographic region. Such an event would cause unprecedented essential service disruptions not only within the power sector, but also for transportation, water, and communications sector infrastructure, as well. Most critically, any communications systems that can operate during such an emergency will be limited in bandwidth (compared with the communications systems that we all use every day), potentially causing an adverse effect on cross-sector coordination efforts. As a result, there is a need to preplan and develop, in advance of such a “Black Sky” power outage, an appropriate human and technical interoperability framework that will support the eventuality of a Black Sky event, and thereby pick out the most-critical data to be generated and shared, so as to be able to conduct restoration and emergency-management activities within the available bandwidth.

Objectives: The objective of this cross-sectional study is to assess the prevalence of facial, oral and dental injuries and frequency of mouth guard use amongst British Men's National Division 1 water polo players. Material and methods: All National League Division 1 water polo club squads were included in the study. Participants were asked to complete a questionnaire that sought information regarding injuries and mouth guard use. Results: One hundred and sixteen completed questionnaires were returned (87% response rate). Ninety four percent of subjects reported having experienced at least one facial, oral or dental injury whilst playing water polo. Of the injuries sustained, those to the lips and tongue were the most prevalent (84.5%). Facial injuries were also common. Forty percent of those injured, reported having sustained at least one dental injury, of which tooth fracture was the most common. More than seventy percent believed that mouth guards were effective at preventing injury but mouth guards were worn regularly when playing by only 8 respondents. Conclusions: It was concluded that facial, oral and dental injuries were very common. Seventy percent believed that mouth guards were effective at preventing injury but mouth guards were worn regularly during matches by few respondents.

With photolithography as the fundamental patterning step in the modern nanofabrication process, every wafer within a semiconductor fab will pass through a lithographic apparatus multiple times. With more than 20,000 sensors producing more than 700GB of data per day across multiple subsystems, the combination of a light source and lithographic apparatus provide a massive amount of information for data analytics. This paper outlines how data analysis tools and techniques that extend insight into data that traditionally had been considered unmanageably large, known as adaptive analytics, can be used to show how data collected before the wafer is exposed can be used to detect small process dependent wafer-towafer changes in overlay.

This paper presents a system architecture of a web GIS that is used to develop a web mapping app for real-time macroeconomic impact decision support tool. It incorporates web GIS on the cloud with an autonomous software system for real-time situational awareness (outage statue and economic loss) from power & electric utilities.Our web GIS is a system of systems, and we deployed ESRI's ArcGIS platform, Amazon Web Services (AWS), enterprise spatial database, C#, RESTful API, and JSON format. The system implementation results in a web GIS that contains a GIS server with a set of REST APIs of GIS web services (map service, geodata service, etc) on the cloud that can be used by web mapping apps, mobile GIS apps, or desktop programs to share, display, analyze, and update a geodatabase, which is embedded in cloud. To evaluate our approach, we developed a web map application and an operations dashboard that used the created GIS web services and APIs. Our web GIS is applicable for the "Internet of Things" domain, public safety, cloud communication, crisis response, web map application, location-based services, and real-time GIS.

With the growing needs of technology and connectivity with the internet, a huge role is laid on WSN for many different applications. Say health care, traffic surveillance, smart house or most importantly in the defence area, sensor networks play a crucial role. This is why sensor networks pose unique security challenges because of their inherent limitations in communication and computing. Dense deployment of sensor networks in an unattended environment makes sensor nodes vulnerable to potential attacks. With these demands, the confidentiality, integrity and authentication of the communicated information becomes very important. In this paper, we have focused on a lightweight encryption method which encompasses faster encryption thereby, bringing down the computing time which increases the overall lifetime of the sensor network. The introduction of both symmetric and asymmetric cryptography in the two phase hybrid encryption algorithm, check marks the main aim of cryptography, i.e, Confidentiality, Integrity and Authenticity. Moreover hybrid encryption attempts to exploit the advantages of both symmetric and asymmetric encryption.

An in-depth discussion on how an industrial network might be attacked, including possible target systems, and the potential consequences should those targets be compromised. Learn how a hacker thinks, how malware works, and what to do if your industrial network becomes infected.

There are several cyber security standards and regulations imposed by governments and industry, which provide everything from “best practices” recommendations to hard requirements that are enforced through penalties and fines. Some common standards are the North American Electric Reliability Corporation's (NERC's) Critical Infrastructure Protection (CIP) Reliability Standards, the US Department of Homeland Security's Chemical Facility Anti-Terrorism Standards (CFATS), and the Regulated Security of Nuclear Facilities by the United States. The Risk-Based Performance Standards (RBPS) for the Chemical Facilities Anti-Terrorism Standards (CFATS) outlines various controls for securing the cyber systems of chemical facilities. Specifically, RBPS Metric 8 (“Cyber”) outlines controls for security policies, access control, personnel security, awareness and training, monitoring and incident response, disaster recovery and business continuity, system development and acquisition, configuration management, and audits. Nuclear Regulatory Commission (NRC) Regulation 5.71 (RG 5.71) provides security recommendations for complying with Title 10 of the Code of Federal Regulations (CFR) 73.54. It consists of an in-depth discussion of the general requirements of cyber security, to specific requirements of planning, establishing, and implementing a cyber security program.

You cannot protect something unless you know what it is, and how it is supposed to behave. So what is an industrial network, and how does it work? A discussion of industrial control system devices and systems, control logic, process loops, and more.

The move from proprietary communications networks to more open networks means that, in order to design an industrial network for robust and reliable operation, you must first understand the basic network architecture and design principles of Ethernet and the Internet Protocol (IP). However, because of the unique nature of industrial networks, these principles must first be adapted to support industrial control and automation.

Enterprise networks have been successfully using Security Monitoring and Analytics tools for years, but these systems are not always easy to deploy or utilize within industrial networks. Learn what systems to monitor, what information to collect, and how to best use it.

Zones and conduits are a fundamental concept of industrial network cyber security. By grouping similar devices or systems into “zones” according to security levels, and controlling communications between zones, a strong foundation of security will be realized. But how do you know what belongs in what zone?

Risk management involves an understanding of threats, vulnerabilities and consequences. To effectively manage risk, therefore, you need to understand how to identify and assess the assets in your industrial network. What devices are vulnerable, and to what types of attack? How could a specific device or system be exploited, and what would the consequences of that exploitation be? Using a variety of risk management standards and methodologies, the risk of a cyber incident can be measured, and used to improve existing security policies, countermeasures, and plans.

With a properly designed and segmented network, there is still the danger of a targeted cyber-attack. To defend these important networks, it is important to know which endpoint- and network-based cyber security controls are available, and how best to use them.

Industrial network communications began with proprietary communications protocols that later evolved to operate over Ethernet and IP. By learning how these protocols work, we can identify how they might be exploited by a cyber-attacker, and also how we might be able to defend them.

Background: An investigation of matrix metalloproteinase-9 (MMP-9) and its influence on vascular invasion in the secondary ossification center at the chondroepiphysis of developing long bones was undertaken. The effect of MMP-9 was compared with that of basic fibroblast growth factor (b-FGF), a potent angiogenic factor, and we assessed the chorioallantoic membrane (CAM) culture as a model for angiogenesis in osteochondral tissue. Methods: Seventy-two femoral and seventy-two humeral heads of thirty-six four-day postnatal rabbits were dissected immediately after each animal was killed. Solutions of MMP-9, b-FGF, and phosphate-buffered saline solution were applied, and the femoral and humeral chondroepiphyseal explants were incubated for ten days in CAM culture. This was used as an in vivo model to investigate the growth of blood vessels into the femoral and humeral heads of the neonatal rabbit. The explants were harvested from the CAM culture and analyzed histologically. A three-day incubation was also performed to look for early signs of vascular ingrowth into the cartilage matrix. Results: One hundred and twenty epiphyses from thirty rabbits were placed onto CAM culture successfully; of these, two were harvested at three days to assess early changes and 118 were harvested at ten days. Forty of the 118 cultures were still viable when harvested after ten days, giving a 33% yield. Both MMP-9 and b-FGF caused an increased vascular invasion into the chondroepiphysis. New blood vessels derived from the chorioallantoic membrane within cartilage canals were more numerous in MMP-9 treated epiphyses, and larger canals were more commonly seen when compared with a control group. Conclusions: These findings confirmed that b-FGF is angiogenic at the chondroepiphysis. Matrix metalloproteinase-9 appears to be implicated in vascular invasion and induces the formation of new cartilage canals at the chondroepiphysis. The CAM culture model was a useful model for investigating angiogenesis in osteochondral tissue. Clinical Relevance: This study adds to the understanding of the complex biochemical interaction that occurs in cartilage when the advancing vasculature begins growing into the chondroepiphysis. A better knowledge of this angiogenic process will enable a better understanding of the pathological failure or disturbance of vasculogenesis, which results in dysplastic growth disorders and osteonecrosis.

To accurately control critical dimension (CD) metrology in a standard real-time solution across a multi-site operation there is a need to collect measure-to-measure and day-to-day variation across all sites. Each individual site's needs, technologies, and resources can affect the final solution. A preferred statistical process control (SPC) solution for testing measure-to-measure and day-to-day variation is the traditional Mean and Range chart. However, replicating the full measurement process needed for the Mean and Range chart in real-time can strain resources. To solve this problem, an initially proposed measurement methodology was to isolate a point of interest, measure the CD feature n number of times, and continue to the next feature; however, the interdependencies in measure-to-measure variation caused by this methodology resulted in exceedingly narrow control limits. This paper explains how traditional solutions to narrow control limits are statistically problematic and explores the approach of computing control limits for the Mean chart utilizing the moving range of sample means to estimate sigma instead of the traditional range method. Tool monitoring data from multiple CD metrology tools are reported and compared against control limits calculated by the traditional approach, engineering limits, and the suggested approach. The data indicate that the suggested approach is the most accurate of the three solutions.