Endoscopic Management of Pediatric Airway and Esophageal Foreign Bodies

The use of endoscopy is critical to the management of pediatric tracheobronchial and esophageal foreign bodies. Children may present with nonspecific symptoms, and the diagnosis can be difficult when the ingestion or aspiration events go unwitnessed. Advances in endoscopic techniques and the use of optical graspers in the removal of foreign bodies in children have helped decrease morbidity and mortality. In this chapter, the history, clinical presentations, workup, and management for pediatric aerodigestive foreign bodies are discussed

Fully coupled photochemistry of the deuterated ionosphere of Mars and its effects on escape of H and D

Although deuterium (D) on Mars has received substantial attention, the deuterated ionosphere remains relatively unstudied. This means that we also know very little about non-thermal D escape from Mars, since it is primarily driven by excess energy imparted to atoms produced in ion-neutral reactions. Most D escape from Mars is expected to be non-thermal, highlighting a gap in our understanding of water loss from Mars. In this work, we set out to fill this knowledge gap. To accomplish our goals, we use an upgraded 1D photochemical model that fully couples ions and neutrals and does not assume photochemical equilibrium. To our knowledge, such a model has not been applied to Mars previously. We model the atmosphere during solar minimum, mean, and maximum, and find that the deuterated ionosphere behaves similarly to the H-bearing ionosphere, but that non-thermal escape on the order of 8000-9000 cm$^{-2}$s$^{-1}$ dominates atomic D loss under all solar conditions. The total fractionation factor, $f$, is $f=0.04$--0.07, and integrated water loss is 147--158 m GEL. This is still less than geomorphological estimates. Deuterated ions at Mars are likely difficult to measure with current techniques due to low densities and mass degeneracies with more abundant H ions. Future missions wishing to measure the deuterated ionosphere in situ will need to develop innovative techniques to do so.Comment: 37 pages, 8 figures, published in Journal of Geophysical Research: Planet

Muscle Fatigue Analysis Using OpenSim

In this research, attempts are made to conduct concrete muscle fatigue analysis of arbitrary motions on OpenSim, a digital human modeling platform. A plug-in is written on the base of a muscle fatigue model, which makes it possible to calculate the decline of force-output capability of each muscle along time. The plug-in is tested on a three-dimensional, 29 degree-of-freedom human model. Motion data is obtained by motion capturing during an arbitrary running at a speed of 3.96 m/s. Ten muscles are selected for concrete analysis. As a result, the force-output capability of these muscles reduced to 60%-70% after 10 minutes' running, on a general basis. Erector spinae, which loses 39.2% of its maximal capability, is found to be more fatigue-exposed than the others. The influence of subject attributes (fatigability) is evaluated and discussed

Nonthermal hydrogen loss at Mars: Contributions of photochemical mechanisms to escape and identification of key processes

Hydrogen loss to space is a key control on the evolution of the Martian atmosphere and the desiccation of the red planet. Thermal escape is thought to be the dominant loss process, but both forward modeling studies and remote sensing observations have indicated the presence of a second, higher-temperature "nonthermal" or "hot" hydrogen component, some fraction of which also escapes. Exothermic reactions and charge/momentum exchange processes produce hydrogen atoms with energy above the escape energy, but H loss via many of these mechanisms has never been studied, and the relative importance of thermal and nonthermal escape at Mars remains uncertain. Here we estimate hydrogen escape fluxes via 47 mechanisms, using newly-developed escape probability profiles. We find that HCO$^+$ dissociative recombination is the most important of the mechanisms, accounting for 30-50% of the nonthermal escape. The reaction CO$_2^+$ + H$_2$ is also important, producing roughly as much escaping H as momentum exchange between hot O and H. Total nonthermal escape from the mechanisms considered amounts to 39% (27%) of thermal escape, for low (high) solar activity. Our escape probability profiles are applicable to any thermospheric hot H production mechanism and can be used to explore seasonal and longer-term variations, allowing for a deeper understanding of desiccation drivers over various timescales. We highlight the most important mechanisms and suggest that some may be important at Venus, where nonthermal escape dominates and much of the literature centers on charge exchange reactions, which do not result in significant escape in this study.Comment: 47 pages, 4 figures, 3 tables. Accepted manuscript. An edited version of this paper was published by AG

Fatigue evaluation in maintenance and assembly operations by digital human simulation

Virtual human techniques have been used a lot in industrial design in order to consider human factors and ergonomics as early as possible. The physical status (the physical capacity of virtual human) has been mostly treated as invariable in the current available human simulation tools, while indeed the physical capacity varies along time in an operation and the change of the physical capacity depends on the history of the work as well. Virtual Human Status is proposed in this paper in order to assess the difficulty of manual handling operations, especially from the physical perspective. The decrease of the physical capacity before and after an operation is used as an index to indicate the work difficulty. The reduction of physical strength is simulated in a theoretical approach on the basis of a fatigue model in which fatigue resistances of different muscle groups were regressed from 24 existing maximum endurance time (MET) models. A framework based on digital human modeling technique is established to realize the comparison of physical status. An assembly case in airplane assembly is simulated and analyzed under the framework. The endurance time and the decrease of the joint moment strengths are simulated. The experimental result in simulated operations under laboratory conditions confirms the feasibility of the theoretical approach

Lumbar muscle size and locations from CT scans of 96 women of age 40 to 63 years

Computed tomography scans of 96 women aged between 40 and 63 years were systematically measured to determine torso muscle moment arms and cross-sectional areas at L2/L3, L3/L4 and L4/L5 disc levels. The major findings were as follows: (1) the mean muscle moment arm and area data were not different bilaterally; (2) psoas, quadratus lumborum, and latissimus dorsi muscle moment arms consistently changed at the three disc levels, while erector spinae, rectus abdominis, transverse abdominis and the oblique muscles remained about the same distance from the three disc centroids; (3) psoas and quadratus lumborum muscles increased in mean size at the lower levels and (4 gross torso anthropometry and body weight had a significant (P r2 from 0[middle dot]12 to 0[middle dot]65) with the size of the erector spinae and psoas muscles, and with the moment arms of the rectus abdominis, transverse abdominis, latissimus dorsi, and oblique muscles.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28726/1/0000549.pd

Deep-coverage whole genome sequences and blood lipids among 16,324 individuals.

Large-scale deep-coverage whole-genome sequencing (WGS) is now feasible and offers potential advantages for locus discovery. We perform WGS in 16,324 participants from four ancestries at mean depth >29X and analyze genotypes with four quantitative traits-plasma total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, and triglycerides. Common variant association yields known loci except for few variants previously poorly imputed. Rare coding variant association yields known Mendelian dyslipidemia genes but rare non-coding variant association detects no signals. A high 2M-SNP LDL-C polygenic score (top 5th percentile) confers similar effect size to a monogenic mutation (~30 mg/dl higher for each); however, among those with severe hypercholesterolemia, 23% have a high polygenic score and only 2% carry a monogenic mutation. At these sample sizes and for these phenotypes, the incremental value of WGS for discovery is limited but WGS permits simultaneous assessment of monogenic and polygenic models to severe hypercholesterolemia

Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment

Background: Evidence-based treatments (EBTs) are available for treating childhood behavioral health challenges. Despite EBTs' potential to help children and families, they have primarily remained in university settings. Little empirical evidence exists regarding how specific, commonly used training and quality control models are effective in changing practice, achieving full implementation, and supporting positive client outcomes. Methods/design: This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359), which is currently in progress, will evaluate the effectiveness of three training models (Learning Collaborative (LC), Cascading Model (CM), and Distance Education (DE)) to implement a well-established EBT , Parent-Child Interaction Therapy, in real-world, community settings. The three models differ in their costs, skill training, quality control methods, and capacity to address broader implementation challenges. The project is guided by three specific aims: (1) to build knowledge about training outcomes, (2) to build knowledge about implementation outcomes, and (3) to test the differential impact of training clinicians using LC, CM, and DE models on key client outcomes. Fifty (50) licensed psychiatric clinics across Pennsylvania were randomized to one of the three training conditions: (1) LC, (2) CM, or (3) DE. The impact of training on practice skills (clinician level) and implementation/sustainment outcomes (clinic level) are being evaluated at four timepoints coinciding with the training schedule: baseline, 6 (mid), 12 (post), and 24 months (1 year follow-up). Immediately after training begins, parent-child dyads (client level) are recruited from the caseloads of participating clinicians. Client outcomes are being assessed at four timepoints (pre-treatment, 1, 6, and 12 months after the pre-treatment). Discussion: This proposal builds on an ongoing initiative to implement an EBT statewide. A team of diverse stakeholders including state policy makers, payers, consumers, service providers, and academics from different, but complementary areas (e.g., public health, social work, psychiatry), has been assembled to guide the research plan by incorporating input from multidimensional perspective. Trial registration: ClinicalTrials.gov: NCT0254335