A qualitative study of the development of a multidisciplinary case conference review methodology to reduce involved margins in pelvic exenteration surgery for recurrent rectal cancer

Aim Pelvic exenteration surgery remains the only curative option for recurrent rectal cancer. Microscopically involved surgical margins (R1) are associated with a higher risk of local recurrence and decreased survival. Our study aimed to develop a post hoc multidisciplinary case conference review and investigate its potential for identifying areas for improvement. Method Results Patients who underwent pelvic exenteration surgery for recurrent rectal cancer with R1 resections at a tertiary referral centre between April 2014 and January 2016 were retrospectively reviewed from a prospectively maintained database. Patients with non-rectal cancers or who underwent palliative surgery were excluded. Cases, imaging and histopathology were evaluated by a dedicated panel including colorectal surgeons, an abdominal radiologist and a gastrointestinal pathologist. R1 resections were reported in 32 of 110 pelvic exenterations. Patients with other tumours were excluded and one patient had a palliative resection. Nine male patients with 11 exenterations were included with a median age of 56 years. All patients had positive soft tissue margins, and one patient also had an involved bony margin. Failures were due to (interdisciplinary) communication problems, specific management of tumour biology (multifocality, spiculated tumours), which can lead to radiological undercalling, and inadequate surgical technical planning. In hindsight, surgery would have been withheld from one patient. Conclusion A retrospective multidisciplinary case evaluation of pelvic exenteration patients with involved surgical margins led to a list of recommendations which included the need to plan for wider surgical soft tissue resections and improvement in interdisciplinary communication. Lessons learned may increase clear margin rates in future resections

MicroLib: A library of 3D microstructures generated from 2D micrographs using SliceGAN

3D microstructural datasets are commonly used to define the geometrical domains used in finite element modelling. This has proven a useful tool for understanding how complex material systems behave under applied stresses, temperatures and chemical conditions. However, 3D imaging of materials is challenging for a number of reasons, including limited field of view, low resolution and difficult sample preparation. Recently, a machine learning method, SliceGAN, was developed to statistically generate 3D microstructural datasets of arbitrary size using a single 2D input slice as training data. In this paper, we present the results from applying SliceGAN to 87 different microstructures, ranging from biological materials to high-strength steels. To demonstrate the accuracy of the synthetic volumes created by SliceGAN, we compare three microstructural properties between the 2D training data and 3D generations, which show good agreement. This new microstructure library both provides valuable 3D microstructures that can be used in models, and also demonstrates the broad applicability of the SliceGAN algorithm

Mucus Sugar Content Shapes the Bacterial Community Structure in Thermally Stressed Acropora muricata

It has been proposed that the chemical composition of a coral’s mucus can influence the associated bacterial community. However, information on this topic is rare, and non-existent for corals that are under thermal stress. This study therefore compared the carbohydrate composition of mucus in the coral Acropora muricata when subjected to increasing thermal stress from 26°C to 31°C, and determined whether this composition correlated with any changes in the bacterial community. Results showed that, at lower temperatures, the main components of mucus were N-acetyl glucosamine and C6 sugars, but these constituted a significantly lower proportion of the mucus in thermally-stressed corals. The change in the mucus composition coincided with a shift from a γ-Proteobacteria- to a Verrucomicrobiae- and α-Proteobacteria-dominated community in the coral mucus. Bacteria in the class Cyanobacteria also started to become prominent in the mucus when the coral was thermally stressed. The increase in the relative abundance of the Verrucomicrobiae at higher temperature was strongly associated with a change in the proportion of fucose, glucose and mannose in the mucus. Increase in the relative abundance of α-Proteobacteria were associated with GalNAc and glucose, while the drop in relative abundance of γ-Proteobacteria at high temperature coincided with changes in fucose and mannose. Cyanobacteria were highly associated with arabinose and xylose. Changes in mucus composition and the bacterial community in the mucus layer occurred at 29°C, which were prior to visual signs of coral bleaching at 31°C. A compositional change in the coral mucus, induced by thermal stress could therefore be a key factor leading to a shift in the associated bacterial community. This, in turn, has the potential to impact the physiological function of the coral holobiont

Establishment of Innovative Shared Departments to Advance Interdisciplinary Education

More and more universities are pursuing interdisciplinary academic activities that span across department and college boundaries. Administrative structures to facilitate such programs are difficult to establish within traditional university frameworks consisting of disciplinary departments and colleges. Often interdisciplinary programs are housed in a traditional disciplinary department or college, or in a standalone center reporting to a college dean or the provost. The difficulty of these structures is obtaining broad buy-in from faculty across departments and having disciplinary degree programs include interdisciplinary coursework. To overcome the difficulties described above, an innovative shared department structure that fosters collaborations to advance interdisciplinary education has been deployed at the University of New Haven. Three shared departments have been established over the last two years: (1) a college-wide department to support interdisciplinary coursework in the first two years of engineering programs; (2) a university-wide department to support entrepreneurship and innovation; and (3) a university-wide department to support health sciences. The shared departments typically have faculty whose tenure home is a traditional disciplinary department. Faculty membership is based on interest and activity level in teaching interdisciplinary courses, participating in interdisciplinary co-curricular activities, and performing interdisciplinary research. A few faculty members may be appointed full-time in a shared department. Like traditional departments, the shared departments have chairs to lead and coordinate activities. Faculty membership can vary from year-to-year depending on their level of activity in the shared department. The shared departments are responsible for approving interdisciplinary courses within their jurisdiction. The chairs of the departments are responsible for reviewing the performance of instructors teaching the interdisciplinary courses, and for providing feedback to disciplinary department chairs on the performance of faculty who are members of the shared department. To date the shared departments have facilitated the following: (1) an Entrepreneurial Engineering Living-Learning Community (LLC) for freshmen; (2) an Innovation and Entrepreneurship LLC for sophomores; (3) an integrated technical communications program across all engineering and computer science programs; (4) an integrated approach to developing entrepreneurial thinking in students across all engineering and computer science programs; (5) the development and teaching of courses on entrepreneurship; and (6) startup weekends and a business plan competition with students drawn from across the university. The detailed structure of the two shared departments and the lessons learned in establishing and operating them is described in this paper

Coral Reef Island Initiation and Development Under Higher Than Present Sea Levels

Coral reef islands are considered to be among the most vulnerable environments to future sea-level rise. However, emerging data suggest that different island types, in contrasting locations, have formed under different conditions in relation to past sea level. Uniform assumptions about reef island futures under sea-level rise may thus be inappropriate. Using chronostratigraphic analysis from atoll rim islands (sand- and gravel-based) in the southern Maldives, we show that whilst island building initiated at different times around the atoll (~2,800 cal. yr. B.P. and ~4,200 cal. yr. B.P. at windward and leeward rim sites respectively), higher than present sea levels and associated high-energy wave events were actually critical to island initiation. Findings thus suggest that projected sea-level rise and increases in the magnitude of distal high-energy wave events could reactivate this process regime which, if there is an appropriate sediment supply, may facilitate further vertical reef island-building

Evidence of Resilience in Reef Islands in Response to Rising Sea Level on Huvadhoo Atoll, Maldives

Reef islands are at the forefront of concern for future accelerating sea-level rise since their low-lying and isolated nature puts them at higher risk of marine inundation compared to continental coastlines. However, the perceived threat of complete submersion as implied by projected future sea-level rise and current island elevations do not consider the morphologically resilient nature of reef island systems. In particular, the role of sediment supply in the resilience of these islands is still relatively poorly studied. This study presents detailed descriptions of the sedimentary characteristics and stratigraphy of two lagoonal platform islands in Huvadhoo Atoll, Maldives, that formed during periods of Holocene sea-level rise. Island subsurface stratigraphy was reconstructed by analysing the skeletal composition and textural properties of 306 sediment samples from 37 cores extracted across the islands. Island sediments were dominated by coral sands with varied proportions of secondary constituents (molluscs, Halimeda, foraminifera, and crustose coralline algae). Downcore variations in composition show that the proportion of coral sands decrease with depth and the proportion of molluscs and Halimeda increase with depth (with the exception of cores that terminated on lagoon infill). The increased proportion of Halimeda and molluscs in these early island deposits may have resulted from the catch-up growth strategy of the reef during the mid-Holocene highstand as both organisms have high turnover rates and directly contribute to sediment production after death. The sedimentological response of increased Halimeda and molluscs highlights the resilient and dynamic nature of reef islands and the ability of reefs to adjust ecologically to changing sea levels

Machine-learning-driven advanced characterization of battery electrodes

Materials characterization is fundamental to our understanding of lithium ion battery electrodes and their performance limitations. Advances in laboratory-based characterization techniques have yielded powerful insights into the structure–function relationship of electrodes, yet there is still far to go. Further improvements rely, in part, on gaining a deeper understanding of complex physical heterogeneities in the materials. However, practical limitations in characterization techniques inhibit our ability to combine data directly. For example, some characterization techniques are destructive, thus preventing additional analyses on the same region. Fortunately, artificial intelligence (AI) has shown great potential for achieving representative, 3D, multi-modal datasets by leveraging data collected from a range of techniques. In this Perspective, we give an overview of recent advances in lab-based characterization techniques for Li-ion electrodes. We then discuss how AI methods can combine and enhance these techniques, leading to substantial acceleration in our understanding of electrodes

Il monastero benedettino di S. Giorgio in Braida a Verona: nuove prospettive di ricerca sulla rifabbrica romanica (sec. XII)

L’attuale aspetto rinascimentale della chiesa di San Giorgio in Braida è frutto di una serie di interventi promossi dai canonici veneziani di San Giorgio in Alga a partire dalla fine del XV secolo. Il monastero benedettino, tuttavia, fu fondato nella metà dell’XI secolo e completamente ricostruito fra il terzo e il quarto decennio del secolo successivo per volere del vescovo Bernardo. L’articolo ripercorre le vicende storiche dell’istituzione in età medievale e rende nota l’esistenza di alcune parti della compagine romanica tuttora inedite, che permettono d’inserire il cantiere di San Giorgio in Braida nel contesto delle coeve manifestazioni architettoniche veronesi

Increased typhoon activity in the Pacific deep tropics driven by Little Ice Age circulation changes

Author Posting. © The Author(s), 2020. This is the author's version of the work. It is posted here by permission of Nature Research for personal use, not for redistribution. The definitive version was published in Bramante, J. F., Ford, M. R., Kench, P. S., Ashton, A. D., Toomey, M. R., Sullivan, R. M., Karnauskas, K. B., Ummenhofer, C. C., & Donnelly, J. P. (2020). Increased typhoon activity in the Pacific deep tropics driven by Little Ice Age circulation changes. Nature Geoscience, 13, 806–811. doi:10.1038/s41561-020-00656-2.The instrumental record reveals that tropical cyclone activity is sensitive to oceanic and atmospheric variability on inter-annual and decadal scales. However, our understanding of the influence of climate on tropical cyclone behaviour is restricted by the short historical record and the sparseness of prehistorical reconstructions, particularly in the western North Pacific, where coastal communities suffer loss of life and livelihood from typhoons annually. Here, to explore past regional typhoon dynamics, we reconstruct three millennia of deep tropical North Pacific cyclogenesis. Combined with existing records, our reconstruction demonstrates that low-baseline typhoon activity prior to 1350 ce was followed by an interval of frequent storms during the Little Ice Age. This pattern, concurrent with hydroclimate proxy variability, suggests a centennial-scale link between Pacific hydroclimate and tropical cyclone climatology. An ensemble of global climate models demonstrates a migration of the Pacific Walker circulation and variability in two Pacific climate modes during the Little Ice Age, which probably contributed to enhanced tropical cyclone activity in the tropical western North Pacific. In the next century, projected changes to the Pacific Walker circulation and expansion of the tropics will invert these Little Ice Age hydroclimate trends, potentially reducing typhoon activity in the deep tropical Pacific.This work was supported by the Strategic Environmental Research and Development Program (SERDP RC-2336). C.C.U. acknowledges support from NSF under AGS-1602455. We thank student intern D. Carter for extensive labwork on core LTD3. We acknowledge the WCRP’s Working Group on Coupled Modelling, which is responsible for CMIP, and we thank the climate modelling groups for producing and making available their model output. CMIP5 model output was provided by the WHOI CMIP5 Community Storage Server via their website: http://cmip5.whoi.edu/. Any use of trade, firm or product names is for descriptive purposes only and does not imply endorsement by the US Government.2021-05-1

Expression of LMO4 and outcome in pancreatic ductal adenocarcinoma

Identification of a biomarker of prognosis and response to therapy that can be assessed preoperatively would significantly improve overall outcomes for patients with pancreatic cancer. In this study, patients whose tumours exhibited high LMO4 expression had a significant survival advantage following operative resection, whereas the survival of those patients whose tumours had low or no LMO4 expression was not significantly different when resection was compared with operative biopsy alone