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Extracorporeal membrane oxygenation (ECMO) is an established rescue therapy for patients with chronic respiratory failure waiting for lung transplantation (LTx). The therapy inherent immobilization may result in fatigue, consecutive deteriorated prognosis and even lost eligibility for transplantation. We conducted a feasibility study on a novel system designed for the deployment of a mobile ECMO device, enabling physical exercise of awake patients prior to LTx. The system comprises a novel mobile oxygenator with a directly connected blood pump, a double lumen cannula, gas blender and supply, as well as control, and energy management. In-vitro experiments included tests regarding performance, efficiency, and blood damage. A reduced system was tested in vivo for feasibility using a novel large animal model. Six anesthetized pigs were first positioned in supine position, followed by a 45° angle, simulating an upright position of the patients. We monitored performance and vital parameters. All in-vitro experiments showed good performance for the respective subsystems and the integrated system. The acute invivo trials of 8h duration confirmed the results. The novel mobile ECMO-system enables adequate oxygenation and decarboxylation sufficient for, e.g., physical exercise of designated LTx-recipients. These results are promising and suggest further preclinical studies on safety and efficacy to facilitate translation into clinical application.

Membrane lungs consist of thousands of hollow fiber membranes packed together as a bundle. The devices often suffer from complications because of non-uniform flow through the membrane bundle, including regions of both excessively high flow and stagnant flow. Here, we present a proof-of-concept design for a membrane lung containing a membrane module based on triply periodic minimal surfaces (TPMS). By warping the original TPMS geometries, the local permeability within any region of the module could be raised or lowered, allowing for the tailoring of the blood flow distribution through the device. By creating an iterative optimization scheme for determining the distribution of streamwise permeability inside a computational porous domain, the desired form of a lattice of TPMS elements was determined via simulation. This desired form was translated into a computer-aided design (CAD) model for a prototype device. The device was then produced via additive manufacturing in order to test the novel design against an industry-standard predicate device. Flow distribution was verifiably homogenized and residence time reduced, promising a more efficient performance and increased resistance to thrombosis. This work shows the promising extent to which TPMS can serve as a new building block for exchange processes in medical devices.

Background Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. Objectives We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool. Methods As part of the Medical Education Translational Resources: Impact and Quality (METRIQ) study, we recruited medical students, EM residents, and EM attendings to evaluate five FOAM posts with the AAT and provide quantitative and qualitative feedback via an online survey. Two independent analysts performed a qualitative thematic analysis with discrepancies resolved through discussion and negotiated consensus. This analysis informed development of an initial revised AAT, which was then further refined after pilot testing among the author group. The final tool was reassessed for reliability. Results Of 330 recruited international participants, 309 completed all ratings. The Best Evidence in Emergency Medicine (BEEM) score was the component most frequently reported as difficult to use. Several themes emerged from the qualitative analysis: for ease of use-understandable, logically structured, concise, and aligned with educational value. Limitations include deviation from questionnaire best practices, validity concerns, and challenges assessing evidence-based medicine. Themes supporting its use include evaluative utility and usability. The author group pilot tested the initial revised AAT, revealing a total score average measure intraclass correlation coefficient (ICC) of moderate reliability (ICC = 0.68, 95% confidence interval [CI] = 0 to 0.962). The final AAT's average measure ICC was 0.88 (95% CI = 0.77 to 0.95). Conclusions We developed the final revised AAT from usability feedback. The new score has significantly increased usability, but will need to be reassessed for reliability in a broad population.

This study aimed to evaluate the genetic diversity of bacterial community associated to different sugarcane genotypes, association habitat and phenological phase of the culture, as well as to isolate, to identify and to characterize your potential for plant growth-promoting. Root and rhizospheric soil samples from RB 92579 and RB 867515 varieties were collected at 120 and 300 days after regrowth (DAR). The diversity of bacterial was evaluated through of the 16S rRNA and nifH genes. We found greater genetic diversity in the root endophytic habitat at 120 DAR. We identify the genera Burkholderia sp., Pantoea sp., Erwinia sp., Stenotrophomonas sp., Enterobacter sp. and Pseudomonas sp. The genera Bacillus sp. and Dyella sp. were only identified in the variety RB 92579. We found indices above 50% for biological nitrogen fixation, production of indole acetic acid and phosphate solubilization, showing that the use of these bacteria in biotechnological products is very promising.

Soil microbial attributes are the most sensitive indicators of changes in soil quality caused by land use. The restoration of areas with salinity and sodicity problems via revegetation has a significant impact on soil attributes. Understanding the response of microbial indicators is essential to maintain the bioavailability of soil organic matter and provides an alternative to land reclamation. Therefore, the objective of this study was to evaluate the efficiency of revegetation on the regeneration of saline soil in a Brazilian semiarid area through evaluating the presence of arbuscular mycorrhizal fungi (AMF) and changes in the soil microbial structure and chemical attributes. A field experiment was performed with a randomized block design of eight treatments: a control (without plant cultivation), monocultures (Atriplex nummularia [Atri], Mimosa caesalpiniifolia [Sab], Leucaena leucocephala [Leu], and Azadirachta indica [Neem]), and intercrops (Atri and Sab, Atri and Neem, and Atri and Leu). Soil composite samples were collected from each plot during the dry and rainy seasons when the plants had completed 24 and 30 months of growth after transplanting, respectively. The cultivation of the saline soil allowed an increase in microbial biomass carbon in both seasons. In the rainy season, the soil basal respiration and metabolic quotient were lower in the cultivated area than in the control area. Spore density and mycorrhizal colonization were higher in the cultivated area than in the control area in both seasons. We provide the first data related to the beneficial effects of revegetation with naturally mycorrhized plants of A. nummularia in monoculture or intercrop on the soil quality of a semiarid area.

Study objective Online educational resources such as blogs are increasingly used for education by emergency medicine clinicians. The Social Media Index was developed to quantify their relative impact. The Medical Education Translational Resources: Indicators of Quality (METRIQ) study was conducted in part to determine the association between the Social Media Index score and quality as measured by gestalt and previously derived quality instruments. Methods Ten blogs were randomly selected from a list of emergency medicine and critical care Web sites. The 2 most recent clinically oriented blog posts published on these blogs were evaluated with gestalt, the Academic Life in Emergency Medicine Approved Instructional Resources (ALiEM AIR) score, and the METRIQ-8 score. Volunteer raters (including medical students, emergency medicine residents, and emergency medicine attending physicians) were identified with a multimodal recruitment methodology. The Social Media Index was calculated in February 2016, November 2016, April 2017, and December 2017. Pearson's correlations were calculated between the Social Media Index and the average rater gestalt, ALiEM AIR score, and METRIQ-8 score. Results A total of 309 of 330 raters completed all ratings (93.6%). The Social Media Index correlated moderately to strongly with the mean rater gestalt ratings (range 0.69 to 0.76) and moderately with the mean rater ALiEM AIR score (range 0.55 to 0.61) and METRIQ-8 score (range 0.53 to 0.57) during the month of the blog post's selection and for 2 years after. Conclusion The Social Media Index's correlation with multiple quality evaluation instruments over time supports the hypothesis that it is associated with overall Web site quality. It can play a role in guiding individuals to high-quality resources that can be reviewed with critical appraisal techniques.

Study objective Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the reliability of gestalt in the assessment of emergency medicine blogs. Methods We identified 60 English-language emergency medicine Web sites that posted clinically oriented blogs between January 1, 2016, and February 24, 2016. Ten Web sites were selected with a random-number generator. Medical students, emergency medicine residents, and emergency medicine attending physicians evaluated the 2 most recent clinical blog posts from each site for quality, using a 7-point Likert scale. The mean gestalt scores of each blog post were compared between groups with Pearson's correlations. Single and average measure intraclass correlation coefficients were calculated within groups. A generalizability study evaluated variance within gestalt and a decision study calculated the number of raters required to reliably (>0.8) estimate quality. Results One hundred twenty-one medical students, 88 residents, and 100 attending physicians (93.6% of enrolled participants) evaluated all 20 blog posts. Single-measure intraclass correlation coefficients within groups were fair to poor (0.36 to 0.40). Average-measure intraclass correlation coefficients were more reliable (0.811 to 0.840). Mean gestalt ratings by attending physicians correlated strongly with those by medical students (r=0.92) and residents (r=0.99). The generalizability coefficient was 0.91 for the complete data set. The decision study found that 42 gestalt ratings were required to reliably evaluate quality (>0.8). Conclusion The mean gestalt quality ratings of blog posts between medical students, residents, and attending physicians correlate strongly, but individual ratings are unreliable. With sufficient raters, mean gestalt ratings provide a community standard for assessment.

The cercospora leaf spot, caused by Cercospora abelmoschi Ellis and Everhart, is quite common in okra culture. Therefore, this study aimed to evaluate the efficiency of aqueous extracts of neem (Azadirachta indica A. Juss), citronella (Cymbopogon nardus (L.) Rendle), eucalyptus (Eucalyptus grandis L.), ecolife®, A. indica oil and fungicide cercobin 700 PM® in control of cercospora leaf spot on okra in greenhouse. The extracts and neem oil were tested in concentration 10%, the fungicide cercobin 700PM® in dose 2.5 g.l-1, applied 10 days after pathogen inoculation by leaf spray and the citric biomass extract ecolife® in concentration 5.0 ml.l-1, applied 10 days before pathogen inoculation. All treatments, except ecolife®, were effective in controlling cercospora leaf spot and may be recommended as alternatives in agroecological systems. © JASEMKeywords: Abelmoschus esculentus, aqueous extracts, Cercospora abelmoschi, fungicide cercobin andgreenhouse.

The cercospora leaf spot, caused by Cercospora abelmoschi Ellis and Everhart, is quite common in okra culture. Therefore, this study aimed to evaluate the efficiency of aqueous extracts of neem ( Azadirachta indica A. Juss), citronella ( Cymbopogon nardus (L.) Rendle), eucalyptus ( Eucalyptus grandis L .), ecolife®, A. indica oil and fungicide cercobin 700 PM® in control of cercospora leaf spot on okra in greenhouse. The extracts and neem oil were tested in concentration 10%, the fungicide cercobin 700PM® in dose 2.5 g.l-1, applied 10 days after pathogen inoculation by leaf spray and the citric biomass extract ecolife® in concentration 5.0 ml.l-1, applied 10 days before pathogen inoculation. All treatments, except ecolife®, were effective in controlling cercospora leaf spot and may be recommended as alternatives in agroecological systems. © JASEM Keywords : Abelmoschus esculentus, aqueous extracts, Cercospora abelmoschi, fungicide cercobin and greenhouse.

J.P.B. de Josselin de Jong, J. Victor Jansen, Oorlog in een primitieve maatschappij. Een overzicht van de wijze van oorlog voeren en de motieven daarvoor bij de Iroquois, en een onderzoek naar de factoren, die ten grondslag lagen aan hun dominerende positie. Van de Rhee’s Drukkerij N.V., Rotterdam 1955. (Amsterd. dissertatie). - P.E. de Josselin de Jong, C.H.M. Heeren-Palm, Polynesische Migraties. J.A. Boom & Zoon, Meppel 1955. (Dissertatie Amsterdam). - P.E. de Josselin de Jong, B. Schrieke, Indonesian Sociological Studies. (Selected writings of B. Schrieke, Part One); W. van Hoeve Ltd, The Hague, Bandung 1955. 295 blz. - G.W.J. Drewes, Nuruddin ar-Raniri, Twee Maleise Geschriften van Nuruddin ar-Raniri, in facsimile uitgegeven met aantekeningen door P. Voorhoeve. Uitgaven van de Stichting De Goeje no. 16, Leiden, E.J. Brill, 1955. 43, 128, 27 blz. - C. Tj. Bertling, Carl A. Schmitz, Balam (Der Tanz- und kultplatz in Melanesien) Verlag Lechte-Emsdetten (Westf.) 1955. (184 blz.; 8 foto’s en kaart). - H. Th. Fischer, Wilhelm Schmidt, Das Mutterrecht. Studia Instituti Anthropos, X, 1955.

J.P.B. de Josselin de Jong, J. Victor Jansen, Oorlog in een primitieve maatschappij. Een overzicht van de wijze van oorlog voeren en de motieven daarvoor bij de Iroquois, en een onderzoek naar de factoren, die ten grondslag lagen aan hun dominerende positie. Van de Rhee’s Drukkerij N.V., Rotterdam 1955. (Amsterd. dissertatie).- P.E. de Josselin de Jong, C.H.M. Heeren-Palm, Polynesische Migraties. J.A. Boom & Zoon, Meppel 1955. (Dissertatie Amsterdam).- P.E. de Josselin de Jong, B. Schrieke, Indonesian Sociological Studies. (Selected writings of B. Schrieke, Part One); W. van Hoeve Ltd, The Hague, Bandung 1955. 295 blz.- G.W.J. Drewes, Nuruddin ar-Raniri, Twee Maleise Geschriften van Nuruddin ar-Raniri, in facsimile uitgegeven met aantekeningen door P. Voorhoeve. Uitgaven van de Stichting De Goeje no. 16, Leiden, E.J. Brill, 1955. 43, 128, 27 blz.- C. Tj. Bertling, Carl A. Schmitz, Balam (Der Tanz- und kultplatz in Melanesien) Verlag Lechte-Emsdetten (Westf.) 1955. (184 blz.; 8 foto’s en kaart).- H. Th. Fischer, Wilhelm Schmidt, Das Mutterrecht. Studia Instituti Anthropos, X, 1955.