Endoscopic Posterior Cricoid Split with Costal Cartilage Graft: A Fifteen‐Year Experience

Objective To evaluate outcomes of the endoscopic posterior cricoid split with rib graft (EPCS/RG) procedure in the treatment of subglottic stenosis (SGS), posterior glottic stenosis (PGS), and bilateral vocal fold immobility (BVFI). Study Design Retrospective chart review. Methods Chart review of all patients who underwent EPCS/RG at a single tertiary-care facility between 1999 and 2014. Patients were grouped based on the primary indication for the procedure. Decannulation was the primary endpoint. Secondary endpoints were the number of subsequent airway procedures and length of hospitalization. Results Thirty-three patients were identified; 32 had tracheotomy. Overall decannulation rate was 65.6%. Subgroup analysis demonstrated the following decannulation rates: 53.8% for SGS, 100% for PGS, and 28.6% for BVFI. Fisher exact test found a significant difference in overall decannulation rates between groups (P = 0.002). Operation-specific decannulation rates for patients who never required an open procedure were 23% for SGS, 91.6% for PGS, and 28.6% for BVFI. This difference was also statistically significant (P = 0.001). Multivariate logistic regression analysis found prematurity had a positive correlation with decannulation that approached statistical significance (P < 0.051; odds ratio 6.1; 95% confidence interval 0.99, 37.6). The percentage of patients who underwent repeat airway procedures for the groups was 61.5% for SGS, 16.6 % for PGS, and 14.3% for BVFI. The median length of hospitalization after EPCS/RG was 3 days. Conclusion This represents the largest series of patients who have undergone EPCS/RG and demonstrates that the majority of patients can be decannulated after this procedure. Patients with PGS had the highest operation-specific decannulation rates

Associations between cardiorespiratory fitness, physical activity and clustered cardiometabolic risk in children and adolescents: the HAPPY study

Clustering of cardiometabolic risk factors can occur during childhood and predisposes individuals to cardiometabolic disease. This study calculated clustered cardiometabolic risk in 100 children and adolescents aged 10-14 years (59 girls) and explored differences according to cardiorespiratory fitness (CRF) levels and time spent at different physical activity (PA) intensities. CRF was determined using a maximal cycle ergometer test, and PA was assessed using accelerometry. A cardiometabolic risk score was computed as the sum of the standardised scores for waist circumference, blood pressure, total cholesterol/high-density lipoprotein ratio, triglycerides and glucose. Differences in clustered cardiometabolic risk between fit and unfit participants, according to previously proposed health-related threshold values, and between tertiles for PA subcomponents were assessed using ANCOVA. Clustered risk was significantly lower (p < 0.001) in the fit group (mean 1.21 ± 3.42) compared to the unfit group (mean -0.74 ± 2.22), while no differences existed between tertiles for any subcomponent of PA. Conclusion These findings suggest that CRF may have an important cardioprotective role in children and adolescents and highlights the importance of promoting CRF in youth

De Sitter and Schwarzschild-De Sitter According to Schwarzschild and De Sitter

When de Sitter first introduced his celebrated spacetime, he claimed, following Schwarzschild, that its spatial sections have the topology of the real projective space RP^3 (that is, the topology of the group manifold SO(3)) rather than, as is almost universally assumed today, that of the sphere S^3. (In modern language, Schwarzschild was disturbed by the non-local correlations enforced by S^3 geometry.) Thus, what we today call "de Sitter space" would not have been accepted as such by de Sitter. There is no real basis within classical cosmology for preferring S^3 to RP^3, but the general feeling appears to be that the distinction is in any case of little importance. We wish to argue that, in the light of current concerns about the nature of de Sitter space, this is a mistake. In particular, we argue that the difference between "dS(S^3)" and "dS(RP^3)" may be very important in attacking the problem of understanding horizon entropies. In the approach to de Sitter entropy via Schwarzschild-de Sitter spacetime, we find that the apparently trivial difference between RP^3 and S^3 actually leads to very different perspectives on this major question of quantum cosmology.Comment: 26 pages, 8 figures, typos fixed, references added, equation numbers finally fixed, JHEP versio

Cardiorespiratory fitness is associated with hard and light intensity physical activity but not time spent sedentary in 10–14 year old schoolchildren: the HAPPY study

Sedentary behaviour is a major risk factor for developing chronic diseases and is associated with low cardiorespiratory fitness in adults. It remains unclear how sedentary behaviour and different physical activity subcomponents are related to cardiorespiratory fitness in children. The purpose of this study was to assess how sedentary behaviour and different physical activity subcomponents are associated with 10–14 year-old schoolchildren's cardiorespiratory fitness

Usability Study of a Control Framework for an Intelligent Wheelchair

We describe the development and assessment of a computer controlled wheelchair called the SMARTCHAIR. A shared control framework with different levels of autonomy allows the human operator to stay in complete control of the chair at each level while ensuring her safety. The framework incorporates deliberative motion plans or controllers, reactive behaviors, and human user inputs. At every instant in time, control inputs from these three different sources are blended continuously to provide a safe trajectory to the destination, while allowing the human to maintain control and safely override the autonomous behavior. In this paper, we present usability experiments with 50 participants and demonstrate quantitatively the benefits of human-robot augmentation

Integrating Human Inputs with Autonomous Behaviors on an Intelligent Wheelchair Platform

Researchers have developed and assessed a computer-controlled wheelchair called the Smart Chair. A shared control framework has different levels of autonomy, allowing the human operator complete control of the chair at each level while ensuring the user\u27s safety. The semiautonomous system incorporates deliberative motion plans or controllers, reactive behaviors, and human user inputs. At every instant in time, control inputs from three sources are integrated continuously to provide a safe trajectory to the destination. Experiments with 50 participants demonstrate quantitatively and qualitatively the benefits of human-robot augmentation in three modes of operation: manual, autonomous, and semiautonomous. This article is part of a special issue on Interacting with Autonomy

Incorporating User Inputs in Motion Planning for a Smart Wheelchair

We describe the development and assessment of a computer controlled wheelchair equipped with a suite of sensors and a novel interface, called the SMARTCHAIR. The main focus of this paper is a shared control framework which allows the human operator to interact with the chair while it is performing an autonomous task. At the highest level, the autonomous system is able to plan paths using high level deliberative navigation behaviors depending on destinations or waypoints commanded by the user. The user is able to locally modify or override previously commanded autonomous behaviors or plans. This is possible because of our hierarchical control strategy that combines three independent sources of control inputs: deliberative plans obtained from maps and user commands, reactive behaviors generated by stimuli from the environment, and user-initiated commands that might arise during the execution of a plan or behavior. The framework we describe ensures the user\u27s safety while allowing the user to be in complete control of a potentially autonomous system

MicroRNAs in pulmonary arterial remodeling

Pulmonary arterial remodeling is a presently irreversible pathologic hallmark of pulmonary arterial hypertension (PAH). This complex disease involves pathogenic dysregulation of all cell types within the small pulmonary arteries contributing to vascular remodeling leading to intimal lesions, resulting in elevated pulmonary vascular resistance and right heart dysfunction. Mutations within the bone morphogenetic protein receptor 2 gene, leading to dysregulated proliferation of pulmonary artery smooth muscle cells, have been identified as being responsible for heritable PAH. Indeed, the disease is characterized by excessive cellular proliferation and resistance to apoptosis of smooth muscle and endothelial cells. Significant gene dysregulation at the transcriptional and signaling level has been identified. MicroRNAs are small non-coding RNA molecules that negatively regulate gene expression and have the ability to target numerous genes, therefore potentially controlling a host of gene regulatory and signaling pathways. The major role of miRNAs in pulmonary arterial remodeling is still relatively unknown although research data is emerging apace. Modulation of miRNAs represents a possible therapeutic target for altering the remodeling phenotype in the pulmonary vasculature. This review will focus on the role of miRNAs in regulating smooth muscle and endothelial cell phenotypes and their influence on pulmonary remodeling in the setting of PAH

Gravitational collapse of a Hagedorn fluid in Vaidya geometry

The gravitational collapse of a high-density null charged matter fluid, satisfying the Hagedorn equation of state, is considered in the framework of the Vaidya geometry. The general solution of the gravitational field equations can be obtained in an exact parametric form. The conditions for the formation of a naked singularity, as a result of the collapse of the compact object, are also investigated. For an appropriate choice of the arbitrary integration functions the null radial outgoing geodesic, originating from the shell focussing central singularity, admits one or more positive roots. Hence a collapsing Hagedorn fluid could end either as a black hole, or as a naked singularity. A possible astrophysical application of the model, to describe the energy source of gamma-ray bursts, is also considered.Comment: 14 pages, 2 figures, to appear in Phys. Rev.

Interim heterogeneity changes measured using entropy texture features on T2- weighted MRI at 3.0 T predict pathological response to neoadjuvant chemotherapy in primary breast cancer

Objectives: This study investigated whether interim changes in hetereogeneity (measured using entropy features) on magnetic resonance images (MRI) were associated with pathological residual cancer burden (RCB) at final surgery in patients receiving neoadjuvant chemotherapy (NAC) for primary breast cancer.Methods: Institutional review board approval was waived for this retrospective study of 88 consenting women (age:30-79). Scanning was performed on a 3.0T MRI scanner prior to NAC (baseline) and after 2-3 cycles of treatment (interim). Entropy was derived from the grey-level co-occurrence matrix, on slice-matched baseline/interim T2- weighted images. Response, assessed using RCB score on surgically resected specimens, was compared statistically with entropy/heterogeneity changes and ROC analysis performed. Prediction of pCR within each tumour immunophenotype was evaluated.Results: Mean entropy percent differences between examinations, by response category, were: pCR:32.8%, RCB-I:10.5%, RCB-II:9.7% and RCB-III:3.0%. Prediction of ultimate pCR from coarse entropy changes between baseline/interim MRI across all lesions yielded 85.2% accuracy (area under ROC curve:0.845). Excellent sensitivity/specificity was obtained for pCR prediction within each immunophenotype: ER+: 100%/100%; HER2+: 83.3%/95.7%, TNBC: 87.5%/80.0%.Conclusions: Lesion T2 heterogeneity changes are associated with response to NAC using RCB scores, particularly for pCR, and can be useful in prediction across all immunophenotypes with good diagnostic accuracy