Structural Neuroimaging of Anorexia Nervosa: Future Directions in the Quest for Mechanisms Underlying Dynamic Alterations.

Anorexia nervosa (AN) is a serious eating disorder characterized by self-starvation and extreme weight loss. Pseudoatrophic brain changes are often readily visible in individual brain scans, and AN may be a valuable model disorder to study structural neuroplasticity. Structural magnetic resonance imaging studies have found reduced gray matter volume and cortical thinning in acutely underweight patients to normalize following successful treatment. However, some well-controlled studies have found regionally greater gray matter and persistence of structural alterations following long-term recovery. Findings from diffusion tensor imaging studies of white matter integrity and connectivity are also inconsistent. Furthermore, despite the severity of AN, the number of existing structural neuroimaging studies is still relatively low, and our knowledge of the underlying cellular and molecular mechanisms for macrostructural brain changes is rudimentary. We critically review the current state of structural neuroimaging in AN and discuss the potential neurobiological basis of structural brain alterations in the disorder, highlighting impediments to progress, recent developments, and promising future directions. In particular, we argue for the utility of more standardized data collection, adopting a connectomics approach to understanding brain network architecture, employing advanced magnetic resonance imaging methods that quantify biomarkers of brain tissue microstructure, integrating data from multiple imaging modalities, strategic longitudinal observation during weight restoration, and large-scale data pooling. Our overarching objective is to motivate carefully controlled research of brain structure in eating disorders, which will ultimately help predict therapeutic response and improve treatment

Mass casualty events: what to do as the dust settles?

Care during mass casualty events (MCE) has improved during the last 15 years. Military and civilian collaboration has led to partnerships which augment the response to MCE. Much has been written about strategies to deliver care during an MCE, but there is little about how to transition back to normal operations after an event. A panel discussion entitled The Day(s) After: Lessons Learned from Trauma Team Management in the Aftermath of an Unexpected Mass Casualty Event at the 76th Annual American Association for the Surgery of Trauma meeting on September 13, 2017 brought together a cadre of military and civilian surgeons with experience in MCEs. The events described were the First Battle of Mogadishu (1993), the Second Battle of Fallujah (2004), the Bagram Detention Center Rocket Attack (2014), the Boston Marathon Bombing (2013), the Asiana Flight 214 Plane Crash (2013), the Baltimore Riots (2015), and the Orlando Pulse Night Club Shooting (2016). This article focuses on the lessons learned from military and civilian surgeons in the days after MCEs

Mobile Open-Source Solar-Powered 3-D Printers for Distributed Manufacturing in Off-Grid Communities

Manufacturing in areas of the developing world that lack electricity severely restricts the technical sophistication of what is produced. More than a billion people with no access to electricity still have access to some imported higher-technologies; however, these often lack customization and often appropriateness for their community. Open source appropriate tech­nology (OSAT) can over­come this challenge, but one of the key impediments to the more rapid development and distri­bution of OSAT is the lack of means of production beyond a specific technical complexity. This study designs and demonstrates the technical viability of two open-source mobile digital manufacturing facilities powered with solar photovoltaics, and capable of printing customizable OSAT in any com­munity with access to sunlight. The first, designed for com­munity use, such as in schools or maker­spaces, is semi-mobile and capable of nearly continuous 3-D printing using RepRap technology, while also powering multiple computers. The second design, which can be completely packed into a standard suitcase, allows for specialist travel from community to community to provide the ability to custom manufacture OSAT as needed, anywhere. These designs not only bring the possibility of complex manufacturing and replacement part fabrication to isolated rural communities lacking access to the electric grid, but they also offer the opportunity to leap-frog the entire conventional manufacturing supply chain, while radically reducing both the cost and the environmental impact of products for developing communities

Mobile Open-Source Solar-Powered 3-D Printers for Distributed Manufacturing in Off-Grid Communities

Manufacturing in areas of the developing world that lack electricity severely restricts the technical sophistication of what is produced. More than a billion people with no access to electricity still have access to some imported higher-technologies; however, these often lack customization and often appropriateness for their community. Open source appropriate tech­nology (OSAT) can over­come this challenge, but one of the key impediments to the more rapid development and distri­bution of OSAT is the lack of means of production beyond a specific technical complexity. This study designs and demonstrates the technical viability of two open-source mobile digital manufacturing facilities powered with solar photovoltaics, and capable of printing customizable OSAT in any com­munity with access to sunlight. The first, designed for com­munity use, such as in schools or maker­spaces, is semi-mobile and capable of nearly continuous 3-D printing using RepRap technology, while also powering multiple computers. The second design, which can be completely packed into a standard suitcase, allows for specialist travel from community to community to provide the ability to custom manufacture OSAT as needed, anywhere. These designs not only bring the possibility of complex manufacturing and replacement part fabrication to isolated rural communities lacking access to the electric grid, but they also offer the opportunity to leap-frog the entire conventional manufacturing supply chain, while radically reducing both the cost and the environmental impact of products for developing communities

The Most Cited Works in Essential Tremor and Dystonia

Background: The study of the most cited works in a particular field gives an indication of the important advances, developments, and discoveries that have had the highest impact in that discipline. Our aim was to identify the most cited works in essential tremor (ET) and dystonia. Methods: A bibliometric search was performed using the ISI Web of Science database using selected search terms for ET and dystonia for articles published from 1900 to 2015. The resulting citation counts were analyzed to identify the most cited works, and the studies were categorized. Results: Using the criterion of more than 400 citations, there were four citation classics for ET and six for dystonia. The most cited studies were those on pathophysiology followed by medical treatments, clinical classification, genetic studies, surgical treatments, review articles, and epidemiology studies. A comparison of the most cited articles for ET and dystonia showed that there was a divergence, with ET and dystonia having a higher number of epidemiologic and genetic studies, respectively. Whereas the peak period for the number of publications was 2000–2004 for ET, it was 1995–1999 for dystonia. Discussion: Given the large number of patients with these disorders, there appears to be an unmet need for further research advances in both areas, but particularly for ET as the most common movement disorder

How Good a Deal Was the Tobacco Settlement?: Assessing Payments to Massachusetts

We estimate the increment in Massachusetts Medicaid program costs attributable to smoking from December 20, 1991, to 1998. We describe how our methods improve upon earlier estimates of analogous costs at the national level. Current costs to the Massachusetts Medicaid program approximate the payments to Massachusetts under the tobacco settlement of November 1998. Whether these payments are viewed as appropriate compensation for Medicaid costs over time depends upon the rate of increase in future health care costs, the rate of decline in smoking, the proportion of smoking that should be attributed to the actions of the tobacco companies and the liklihood that state would have prevailed at trial. The costs to the Medicaid program are dwarfed by the internal costs to smokers themselves.

Clinical significance of perioperative Q-wave myocardial infarction: The Emory Angioplasty versus Surgery Trial

AbstractObjective: The primary end point of the Emory Angioplasty versus Surgery Trial was a composite of three events: death, Q-wave infarction, and a new large defect on 3-year postoperative thallium scan. This study examines the clinical significance of Q-wave infarction in the surgical cohort (194 patients) of the Emory trial. Methods: Twenty patients (10.3%) with Q-wave infarctions were identified: 13 patients had inferior Q-wave infarctions and seven patients had anterior, lateral, septal, or posterior Q-wave infarctions (termed anterior Q-wave infarctions). Results: In the inferior Q-wave infarction group, postoperative cardiac catheterization (at 1 year or 3 years) in 11 patients revealed normal ejection fraction (ejection fraction >55%) in 10 (91%), no wall motion abnormalities in 10 (91%), and all grafts patent in 10 (91%). In the anterior Q-wave infarction group, postoperative catheterizatiOn in six patients revealed normal ejection fractions in five (83%), no wall motion abnormalities in three (50%), and all grafts patent in three (50%). Average peak postoperative creatine kinase MB levels were as follows: no Q-wave infarction (n = 174) 37 ± 43 IU/L, inferior Q-wave infarction 40 ± 27 IU/L, and anterior Q-wave infarction 58 ± 38 IU/L. Mortality in the 20 patients with Q-wave infarctions was 5% (1/20) at 3 years; in patients without a Q-wave infarction it was 6.3% (11/174) (p = 0.64). Of 17 patients with a Q-wave infarction who underwent postoperative catheterization, 11 (65%) had a normal ejection fraction, normal wall motion, and all grafts patent with an uneventful 3-year postoperative course. Conclusions: The core laboratory screening of postoperative electrocardiograms, particularly in the case of inferior Q-wave infarctions, appears to identify a number of patients as having a Q-wave infarction with minimal clinical significance. Q-wave infarction identified in the postoperative period seems to be a weak end point with little prognostic significance and therefore not valuable for future randomized trials. (J Thorac Cardiovasc Surg 1996;112:1447-54

Micro-scale Artificial Weave Generation Capabilities for Thermal Protection System Material Modeling

Thermal Protection System (TPS) modeling requires accurate representation and prediction of the thermomechanical behavior of ablative materials. State-of-the-art TPS materials such as Phenolic Impregnated Carbon Ablator (PICA) have a proven flight record and demonstrate exceptional capabilities for handling extreme aerothermal heating conditions. The constant push for lightweight materials that are flexible in their design and performance, and hence allow for a wide range of mission profiles, has led NASA over the past years to develop its Heatshield for Extreme Entry Environment Technology (HEEET). HEEET is based primarily on a dual layer woven carbon fiber architecture and the technology has successfully been tested in arc-jet facilities. These recent developments have sparked interest in the accurate micro-scale modeling of composite weave architectures, to predict the structural response of macro-scale heatshields upon atmospheric entry. This effort can be extended to incorporate in-depth failure mechanics analyses as a result of local thermal gradients or high-velocity particle impact

Molecular Physics

Contains reports on two research projects.F.L. Freidman ChairNational Institutes of Health (Grant AM 25535)Whitaker FoundationInternational Business Machines, Inc