Hernia Prevention Using Biologic Mesh and/or Small Bites: A Multispecialty 2 × 2 Factorial Randomized Controlled Trial

BACKGROUND: Ventral incisional hernias are the most common complication after abdominal operation. Randomized trials have shown efficacy of prophylactic synthetic mesh and small bites. Adoption of these practices has been limited due to concerns with placement of synthetic mesh in contaminated cases and small bites in an overweight population. We sought to assess the efficacy of prophylactic biologic mesh and small bites to prevent postoperative major complications: ventral incisional hernias, surgical site infection, reoperation, and death. STUDY DESIGN: High-risk patients (overweight/obese, current smoker) undergoing abdominal operation with a midline incision (5 cm or greater) were randomized (2 × 2 factorial trial) to receive either sublay biologic mesh or no mesh and either small bites (0.5 × 0. 5cm) or large bites (1 × 1 cm) fascial closure. The primary outcome measure was major complications at 1 year postoperative. CONSORT guidelines were followed, and this study was registered on clinicaltrials.gov (NCT03148496). Assuming α = 0.05, β = 0.20, and Δ = 20%, it was estimated that 105 patients were needed. Primary outcome was assessed using Fisher\u27s exact test. RESULTS: A total of 107 patients were randomized: 52 (49%) to mesh, 55 (51%) to no mesh, 55 (51%) to small bites, and 52 (49%) to large bites. Of the patients, 16% were smokers, 31% were overweight, and 55% were obese. At 1 year postoperative, there were no differences in major complications between groups (mesh vs no mesh 21% vs 16%, p = 0.62; small vs large bites 18% vs 19%, p = 1.00). CONCLUSIONS: In this trial, biologic mesh and small bites appear to have no benefit. Further randomized trials are needed among high-risk patients before widespread adoption of prophylactic biologic mesh or small bites

Cognitive and emotional empathy in individuals at clinical high risk of psychosis

Background Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive. Methods Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined. Results Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms. Conclusion Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored

Performing identity: the case of the (Greek) Cypriot National Guard

Students of International Relations are taught that the modern nation-state has a monopoly on the (legitimate) use of violence. However, in the case of the Republic of Cyprus this does not seem to be the case, since its armed forces, the Cypriot National Guard (CNG), are intimately embedded within Greece’s military structure, and half the island remains under Turkish occupation. The colonization of Cyprus (1571–1960) and subsequent decolonization has led to the gradual construction of two rigid identities, Greek and Turkish, that have been institutionalized legally and imposed constitutionally. This paper seeks to answer two questions. First, how does the CNG perform and therefore constitute a ‘Greek identity’? Second, is this performance epistemically violent, hindering the formation of hybrid identities? We use autoethnography, interviews, and insights from Pierre Bourdieu’s concept of the habitus and Judith Butler’s performativity theory to explore these two questions. We argue that the CNG performs a Greek identity in three key configurations: 1) the operational link between the Greek Army and the CNG; 2) the explicit connection to both ancient and modern Greece through various CNG insignia and practices, including parades and marching songs; and 3) the entrenchment of the Greek Orthodox Church within its practices

The use of updated robust reliability measures in stochastic dynamical systems

This work explores the effect of using updated robust reliability measures in the context of stochastic structural dynamical systems. A Bayesian probabilistic methodology for model updating is first implemented for the purpose of updating the structural model using dynamic data. The updated distribution of the system model parameters is then used to implement a strategy for updating the system reliability. The effect of the updated information on the robust performance and design of dynamical systems under stochastic excitation and modeling uncertainty is illustrated by several example problems. (C) 2013 Elsevier B.V. All rights reserved

Model-reduction techniques for Bayesian finite element model updating using dynamic response data

This work presents a strategy for integrating a class of model reduction techniques into a finite element model updating formulation. In particular a Bayesian model updating approach based on a stochastic simulation method is considered in the present formulation. Stochastic simulation techniques require a large number of finite element model re-analyses to be performed over the space of model parameters during the updating process. Substructure coupling techniques for dynamic analysis are proposed to reduce the computational cost involved in the dynamic re-analyses. The effectiveness of the proposed strategy is demonstrated with identification and model updating applications for finite element building models using simulated seismic response data. (C) 2014 Elsevier B.V. All rights reserved

Rusty, Jammed, and Well-Oiled Hinges: Mutations Affecting the Interdomain Region of FliG, a Rotor Element of the Escherichia coli Flagellar Motor

The FliG protein is a central component of the bacterial flagellar motor. It is one of the first proteins added during assembly of the flagellar basal body, and there are 26 copies per motor. FliG interacts directly with the Mot protein complex of the stator to generate torque, and it is a crucial player in switching the direction of flagellar rotation from clockwise (CW) to counterclockwise and vice versa. A primarily helical linker joins the N-terminal assembly domain of FliG, which is firmly attached to the FliF protein of the MS ring of the basal body, to the motility domain that interacts with MotA/MotB. We report here the results of a mutagenic analysis focused on what has been called the hinge region of the linker. Residue substitutions in this region generate a diversity of phenotypes, including motors that are strongly CW biased, infrequent switchers, rapid switchers, and transiently or permanently paused. Isolation of these mutants was facilitated by a “sensitizing” mutation (E232G) outside of the hinge region that was accidentally introduced during cloning of the chromosomal fliG gene into our vector plasmid. This mutation partially interferes with flagellar assembly and accentuates the defects associated with mutations that by themselves have little phenotypic consequence. The effects of these mutations are analyzed in the context of a conformational-coupling model for motor switching and with respect to the structure of the C-terminal 70% of FliG from Thermotoga maritima