MULTI-OBJECTIVE DESIGN OPTIMIZATION OF REVERSE TOTAL SHOULDER ARTHROPLASTY TO MAXIMIZE RANGE OF MOTION AND JOINT STABILITY

Reverse total shoulder arthroplasty was developed to restore range of motion (ROM) and joint stability to patients with pre-operative conditions that are not addressed by conventional replacements. Although reverse total shoulder arthroplasty is the current gold standard for treating a range of indications, the effects of varying its design on functional outcomes of the procedure are still not well understood. To that end, it is not yet clear which configurations, in terms of both design and surgical placement parameters, maximize range of motion and stability of the joint. It was hypothesized that there is trade-off between the two. These types of relationships may be elucidated using multi-objective design optimization to generate a Pareto front. Pareto optimal points represent those where neither performance metric can be further improved without detriment to the other. Multi-objective optimization requires 1) metrics to characterize the objectives to be optimized and 2) an automated computational framework capable of assessing the metrics for any candidate implant design. As such, the pre-cursory goals to performing multi-objective optimization involved the development, validation, and automation of computational tools to predict the performance of reverse should designs with respect to range of motion and joint stability. Characterization of the Pareto front with multi-objective optimization confirmed that there is in fact a trade-off between range of motion and stability. Designs that maximize one functional outcome differ from those that maximize the other. Designs that resulted in intermediate performance in terms of both objectives were variable. This indicates that functional factors other than range of motion and stability, such as mechanical implant stability (fixation) and avoidance of inferior impingement, could serve as deciding factors between implant configurations that achieve similar range of motion and stability results

Innovations in Sentencing: The Use of Scarlet Letter Dispositions

Scarlet letter sentencing dispositions are innovative alternatives to incarceration posited as special probation conditions granted to offenders deemed able to live in the community. These sanctions resemble scarlet letter punishments of the Seventeenth Century as illustrated in Nathaniel Hawthorne’s Scarlet Letter for Hester Prynne. They are designed as bumper or windshield stickers, yard signs, screen prints on T-shirts, and public apologies. This study investigates the proliferation of these innovative penalties created by judges to require drunk drivers, sex offenders, thieves/burglars, white-collar criminals, and drug offenders to publicly disclose the nature of their crime and identify themselves as perpetrators. Societal and inmate attitudes toward crime and punishment are considered to determine if the threat of public exposure can deter criminal activity and protect the public. Convicted offenders’ perception of probation as punishment versus incarceration is considered to determine whether they fear probation more than imprisonment. The legal context of judicial discretion and the use of scarlet letter dispositions suggests problems with judicial reviewability and the advantages and disadvantages of using scarlet letters to punish convicted offenders. An exploratory study of Nebraska’s 4th Judicial District Judges was conducted. The feasibility of scarlet letter dispositions may only be meaningful to those judges who impose them

Direct observation of interface instability during crystal growth

The general aim of this investigation was to study interface stability and solute segregation phenomena during crystallization of a model system. Emphasis was to be placed on direct observational studies partly because this offered the possibility at a later stage of performing related experiments under substantially convection-free conditions in the space shuttle. The major achievements described in this report are: (1) the development of a new model system for fundamental studies of crystal growth from the melt and the measurement of a range of material parameters necessary for comparison of experiment with theory. (2) The introduction of a new method of measuring segregation coefficient using absorption of a laser beam by the liquid phase. (3) The comparison of segregation in crystals grown by gradient freezing and by pulling from the melt. (4) The introduction into the theory of solute segregation of an interface field term and comparison with experiment. (5) The introduction of the interface field term into the theories of constitutional supercooling and morphological stability and assessment of its importance

Cerebral and Peripheral Tissue Oxygenation in Children Supported on ECMO for Cardio-Respiratory Failure

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with cardio-respiratory failure. Establishing, maintaining and weaning from ECMO may increase the risk for intracranial injury. We used a dual channel near infrared system to monitor cerebral and peripheral tissue oxygenation in 3 venoarterial (VA) and 1 venovenous (VV) ECMO patients undergoing manipulations in the ECMO circuit flows. Spectral analysis was performed on the oxyhaemoglobin data collected from these patients with the aim of comparing oscillations at range of frequencies appearing in the two measurement sites

Analysis of the Changes in the Oxidation of Brain Tissue Cytochrome-c-Oxidase in Traumatic Brain Injury Patients during Hypercapnoea A Broadband NIRS Study

Using broadband near-infrared spectroscopy (NIRS) and cerebral micro-dialysis (MD), we investigated cerebral cellular metabolism and mitochondrial redox states, following hypercapnoea in 6 patients with traumatic brain injury (TBI). In all patients hypercapnoea increased intracranial pressure and cerebral blood flow velocity measured with transcranial Doppler. Despite the likely increase in cerebral oxygen delivery, we did not see an increase in the oxidation status of cytochrome-c-oxidase [oxCCO] in every patient. Analysis of the NIRS data demonstrated two patterns of the changes; Group A (n = 4) showed an increase in [oxCCO] of 0.34(+/-0.34)mu M and Group B (n = 2) a decrease of 0.40(+/- 0.41)mu M. Although no obvious association was seen between the Delta[oxCCO] and the MD, measured changes in lactate and pyruvate concentrations. Further work using model informed data interpretation may be helpful in understanding the multimodal signals acquired in this heterogeneous patient group

Adaptive Normalization in Streaming Data

In todays digital era, data are everywhere from Internet of Things to health care or financial applications. This leads to potentially unbounded ever-growing Big data streams and it needs to be utilized effectively. Data normalization is an important preprocessing technique for data analytics. It helps prevent mismodeling and reduce the complexity inherent in the data especially for data integrated from multiple sources and contexts. Normalization of Big Data stream is challenging because of evolving inconsistencies, time and memory constraints, and non-availability of whole data beforehand. This paper proposes a distributed approach to adaptive normalization for Big data stream. Using sliding windows of fixed size, it provides a simple mechanism to adapt the statistics for normalizing changing data in each window. Implemented on Apache Storm, a distributed real-time stream data framework, our approach exploits distributed data processing for efficient normalization. Unlike other existing adaptive approaches that normalize data for a specific use (e.g., classification), ours does not. Moreover, our adaptive mechanism allows flexible controls, via user-specified thresholds, for normalization tradeoffs between time and precision. The paper illustrates our proposed approach along with a few other techniques and experiments on both synthesized and real-world data. The normalized data obtained from our proposed approach, on 160,000 instances of data stream, improves over the baseline by 89% with 0.0041 root-mean-square error compared with the actual data

Hyperoxia results in increased aerobic metabolism following acute brain injury

Acute brain injury is associated with depressed aerobic metabolism. Below a critical mitochondrial pO2 cytochrome c oxidase, the terminal electron acceptor in the mitochondrial respiratory chain, fails to sustain oxidative phosphorylation. After acute brain injury, this ischaemic threshold might be shifted into apparently normal levels of tissue oxygenation. We investigated the oxygen dependency of aerobic metabolism in 16 acutely brain-injured patients using a 120-min normobaric hyperoxia challenge in the acute phase (24–72 h) post-injury and multimodal neuromonitoring, including transcranial Doppler ultrasound-measured cerebral blood flow velocity, cerebral microdialysis-derived lactate-pyruvate ratio (LPR), brain tissue pO2 (pbrO2), and tissue oxygenation index and cytochrome c oxidase oxidation state (oxCCO) measured using broadband spectroscopy. Increased inspired oxygen resulted in increased pbrO2 [ΔpbrO2 30.9 mmHg p < 0.001], reduced LPR [ΔLPR −3.07 p = 0.015], and increased cytochrome c oxidase (CCO) oxidation (Δ[oxCCO] + 0.32 µM p < 0.001) which persisted on return-to-baseline (Δ[oxCCO] + 0.22 µM, p < 0.01), accompanied by a 7.5% increase in estimated cerebral metabolic rate for oxygen (p = 0.038). Our results are consistent with an improvement in cellular redox state, suggesting oxygen-limited metabolism above recognised ischaemic pbrO2 thresholds. Diffusion limitation or mitochondrial inhibition might explain these findings. Further investigation is warranted to establish optimal oxygenation to sustain aerobic metabolism after acute brain injury

Parents in transition: Experiences of parents of young people with a liver transplant transferring to adult services

Predictors of successful transition from pediatric to adult services include ability to self-manage and engage with healthcare services. Parents have a key role in healthcare management throughout childhood and adolescence including encouraging development of self-management skills in their children. Transition to adult services can be challenging for parents and young people, yet parents' views regarding transition remain largely unexplored. Nine parents of pediatric liver transplant recipients (15.2-25.1 yr) participated in semistructured interviews. Interviews were analyzed using IPA. Analysis revealed three key themes: "emotional impact of transplantation," "protection vs. independence," and "ending relationships and changing roles." Parents expressed the dichotomous nature of the desire to promote independence in their child while still maintaining control and protection, and discussed how changing roles and relationships were difficult to navigate. Parents are important facilitators of young people's development of self-management skills for successful transfer to adult services. Parents should be supported to move from a "managerial" to a "supervisory" role during transition to help young people engage independently with the healthcare team. Findings support the development of interventions for parents to emphasize their role in transition and guide the transfer of self-management skills from parent to young person

Measurement of Physical and Chemical Changes Induced During Weathering of A Carbonate Rock Unit

Changes which occurred during weathering of the Iowa Falls Member of the Mississippian Hampton Formation at Iowa Falls, Iowa were investigated quantitatively. The physical properties measured were: a) compressive strength, b) pore sized distribution, c) porosity and d) permeability. Chemically determined calcite and dolomite contents are related to the physical changes by utilization of an extensive sample sequence. The following changes are shown to be associated with the weathering process: 1) pore space and the degree of its interconnectedness increases with weathering, 2) calcite and dolomite are leached out during weathering, and 3) the rate of removal of calcite is twice that of dolomite