Predictive and Protective Factors for Partial Necrosis in DIEP Flap Breast Reconstruction. Does Nulliparity Bias Flap Viability?

Although success rate of deep inferior epigastric perforator (DIEP) flap breast reconstruction has greatly improved, complications still occasionally occur. Perfusion-related complications (PRCs) (ie, fat necrosis and partial flap necrosis) are the most frequent concern, affecting aesthetic final result of the reconstructed breast.The aim of our study was to retrospectively investigate 287 consecutive DIEP flap breast reconstructions to investigate predictive and protective factors for PRCs.From May 2004 to February 2012, 287 DIEP flap breast reconstructions were performed on 270 patients; 247 unilateral flaps, including Holm vascular zones I to III, were retrospectively selected and analyzed. Tobacco use, mean blood pressure over the first postoperative 48 hours, superficial epigastric vein drainage, medial/lateral row perforator, nulliparity, crystalloid versus combined crystalloid/colloid intravenous fluid infusion therapy, and learning curve were evaluated by univariate and multivariate logistic regression analyses.Perfusion-related complications occurred 32 (12.9%) times, 79 (31.9%) patients were smokers, 48 (19.4%) showed postoperative mean blood pressure less than 75 mm Hg, 29 (11.7%) were nulliparous, and 173 (70%) had superficial epigastric vein drainage. Selected perforators were 110 (44.5%) from lateral row, 137 (55.5%) from medial row; 91 (36.8%) received crystalloid fluid infusion, whereas 156 (63.2%) combined crystalloid/colloid fluid infusion. From univariate analysis emerged significance of nulliparity, perforator row and intravenous fluid infusion for PRC. Nevertheless, multivariate model confirmed only nulliparity as a significant risk factor (P = 0.029), although variable correlations to other predictors were found: both medial row perforator and combined crystalloid/colloid fluid infusion potentially decrease the PRC risk of 11.6% and 27.6%, respectively. Learning curve did not show significant decrease of PRC risk over time.Our study first proved nulliparity as a statistically significant predictor for PRCs in DIEP flap breast reconstruction, possibly due to different superficial abdominal perfusion between pluriparous and nulliparous women, with potential weaker pattern of perforators and smaller angiosomes in the latter. The choice of medial row perforators and combined crystalloid/colloid fluid infusion might reduce PRC risk

Los programas de microcrédito en Turquía: un paso hacia el empoderamiento de las mujeres

In developing countries, the economic potential of women has long been under-utilized as a means of lifting households and communities out of poverty. In this respect, microcredit schemes offer an innovative form of social welfare, widely accessible to women. This study examines one such program from the Turkish context: the Maya Enterprise for Micro Finance, a conditional credit opportunity for women to start and/or develop their own businesses, granted by the Foundation for the Support of Women’s Work (KEDV). Our study aimed to explore the impact of KEDV's credit transfer scheme on the lives of users, especially in terms of the psychological and economic empowerment of women. Deploying a mixed methods research strategy, we administered and analyzed quantitative surveys (n=336) in order to determine the perceptions, thoughts, insights and reactions of KEDV program users, also conducting qualitative interviews with 21 participants. Our findings indicate that the program was influential in empowering women by increasing their self-confidence and changing their relationship with other people in the household.En los países en desarrollo, el potencial económico de las mujeres ha sido subutilizado durante mucho tiempo como un medio para sacar a los hogares y las comunidades de la pobreza. A este respecto, los planes de microcrédito ofrecen una forma innovadora de bienestar social, que es ampliamente accesible para las mujeres. Este estudio examina uno de esos programas desde el contexto turco: Maya Enterprise for Micro Finance, una oportunidad de crédito condicional para que las mujeres comiencen y/o desarrollen sus propios negocios, otorgada por la Fundación para el Apoyo al Trabajo de las Mujeres (KEDV). El objetivo de nuestro estudio fue explorar el impacto del esquema de transferencia de crédito de KEDV en la vida de las usuarias, especialmente en términos del empoderamiento psicológico y económico de las mujeres. Para ello, se siguió una estrategia de investigación de métodos mixtos, aplicando y analizando encuestas cuantitativas (n=336) para determinar las percepciones, pensamientos, ideas y reacciones de las usuarias del programa KEDV, y también mediante entrevistas cualitativas con 21 participantes. Nuestros hallazgos indican que el programa influyó en el empoderamiento de las mujeres, al aumentar su autoconfianza y cambiar su relación con otras personas en el hogar

Measuring uncertainty in human visual segmentation

Segmenting visual stimuli into distinct groups of features and visual objects is central to visual function. Classical psychophysical methods have helped uncover many rules of human perceptual segmentation, and recent progress in machine learning has produced successful algorithms. Yet, the computational logic of human segmentation remains unclear, partially because we lack well-controlled paradigms to measure perceptual segmentation maps and compare models quantitatively. Here we propose a new, integrated approach: given an image, we measure multiple pixel-based same--different judgments and perform model--based reconstruction of the underlying segmentation map. The reconstruction is robust to several experimental manipulations and captures the variability of individual participants. We demonstrate the validity of the approach on human segmentation of natural images and composite textures. We show that image uncertainty affects measured human variability, and it influences how participants weigh different visual features. Because any putative segmentation algorithm can be inserted to perform the reconstruction, our paradigm affords quantitative tests of theories of perception as well as new benchmarks for segmentation algorithms.Comment: 27 pages, 9 figures, 4 appendix, 3 figures in appendi

Microwave Regeneration and Thermal and Oxidative Stability of Imidazolium Cyanopyrrolide Ionic Liquid for Direct Air Capture of Carbon Dioxide

Understanding the oxidative and thermal degradation of CO2 sorbents is essential for assessing long-term sorbent stability in direct air capture (DAC). The potential degradation pathway of imidazolium cyanopyrrolide, an ionic liquid (IL) functionalized for superior CO2 capacity and selectivity, is evaluated under accelerated degradation conditions to elucidate the secondary reactions that can occur during repetitive absorption-desorption thermal-swing cycles. The combined analysis from various spectroscopic, chromatographic, and thermal gravimetric measurements indicated that radical and SN2 mechanisms in degradation are encouraged by the nucleophilicity of the anion. Thickening of the liquid and gas evolution are accompanied by 50 % reduction in CO2 capacity after a 7-day exposure to O2 under 80 °C. To prevent long exposure to conventional thermal heating, microwave (MW) regeneration of the CO2-reactive IL is used, where dielectric heating at 80 and 100 °C rapidly desorbs CO2 and regenerates the IL without any measurable degradation