An inclusion-free edge-coloring of a graph G with δ(G)≥2 is a proper edge-coloring in which the color set of a vertex u is not contained in the color set of a neighbor of u. The least number of colors required in an inclusion-free edge-coloring is the inclusion chromatic index, denoted by χ⊂′(G). In the paper, we show that if G is a bipartite graph with bipartition (A,B) where Δ(A)≤3 and δ(G)≥2, then χ⊂′(G)≤2Δ+1.
Introduction Trauma-specific performance improvement (PI) activities are highly variable among Emergency Medical Services (EMS) providers. This study assesses the perception of the trauma PI activities of EMS providers in the state of Ohio and identifies potential barriers to conducting a successful program. Methods An institutional review board–approved, voluntary, and anonymous Qualtrics survey was disseminated to all EMS agencies registered under the Ohio Department of Public Safety throughout the 88 counties of Ohio. It included questions regarding what agencies considered trauma-specific PI activities, how frequently they completed those activities, and barriers related to conducting such PI activities. There were both open-ended and closed-ended questions in the survey, along with a follow-up interview. The data were descriptively and thematically analyzed. Results From the recorded responses (341), most the respondents (98.5%) either agreed or strongly agreed that trauma-specific PI activities improve performance of EMS providers, while only 63.8% (218) of the agencies performed them. Some activities considered as trauma PI and conducted at least once a month included (1) record keeping (74.6%), (2) confirmation on the use of correct triage protocols (66.9%), (3) measuring response time on trauma calls (60.0%), (4) PI reviews of trauma cases (56.9%), and (5) obtaining feedback from the receiving facility and or authorizing physicians (48.5%). Primary barriers to performing trauma PI activities included a lack of interest and financial resources, followed by system-level reasons such as unavailability of training centers and a lack of regional/state support. Thematic analysis of the data suggested that improved communication and awareness of trauma PI, sharing statewide data on trauma PI, better synchronization among EMS agencies and trauma centers, and enhanced EMS funding could potentially improve trauma-specific PI programs at the EMS level. Conclusions Our results showed variability in the perception, execution, and availability of trauma-specific PI activities among EMS agencies in the state. Common barriers could potentially be mitigated by collaboration between agencies, trauma centers, and state-led initiatives. With the increased frequency of mass shootings and other large-scale trauma disasters, it is imperative from a state and regional level to address these inconsistencies and further elucidate effective measures of trauma PI for the EMS community.
Given two graphs G,H and a positive integer k, the Gallai-Ramsey number grk(G:H) is the minimum integer N such that for all n≥N, every exact k-edge-coloring of Kn contains either a rainbow copy of G or a monochromatic copy of H. A fan Fq is obtained from a matching of size q by adding a vertex adjacent to all vertices in the matching; while a wheel graph Ws is obtained from a cycle of size s−1 by adding a vertex adjacent to all vertices on the cycle. In this paper, we determine either the exact values or some bounds for the Gallai-Ramsey numbers grk(P5:H)(k≥3) where H is either a fan or a wheel graph.
We present a case of vertebral osteomyelitis following multiple vertebral augmentations in a patient with an insidious presentation. Vertebral augmentation (kyphoplasty and/or vertebroplasty) is a minimally invasive procedure that has become a fairly common and highly effective method in treating compression fractures. A large majority of patients that undergo this procedure suffer from osteoporosis. Numerous studies have shown that patients who undergo the procedure obtain substantial pain relief and improve functional status, often times to a greater extent than other surgical and nonsurgical management. Although its prevalence is low, infection after vertebral augmentation can be a serious consequence of the procedure. Blood cultures in this case were positive for Clostridium septicum. C septicum is a gram-positive, spore forming bacteria that is part of the normal gut flora in humans and is commonly associated with GI malignancy, necrosis, and inflammation. The patient did not respond to long-term intravenous antibiotics and required vertebral corpectomy and debridement with instrumentation. Vertebral body cultures obtained intraoperatively were positive for C septicum. It was noted historically that the patient had a hemorrhoidectomy 4 weeks prior to her initial fracture presentation. Although the risk of infection after vertebral augmentation is low, it is imperative that careful pre- and postoperative evaluation as well as follow-up is completed in order to prevent catastrophic consequences for patients. In patients with recent gastrointestinal tract manipulation/surgery, appropriate antibiotic prophylaxis should be considered prior to vertebral augmentation procedures.
Introduction Splenic artery embolization (SAE) is a routinely used adjunct in the nonoperative management (NOM) of blunt splenic injury (BSI). The purpose of this study was to evaluate the rate and type of adverse events that occur in patients undergoing SAE and to compare this with the previous data. Methods Patients who had SAE for BSI between 2011 and 2018 were identified. Splenic abscess, splenic infarction, and contrast-induced renal insufficiency were considered major complications. Coil migration, fever, and pleural effusions were regarded minor complications. The results were compared with data from a prior study examining similar indices at the same trauma center between 2000 and 2010. Results There were 716 patients admitted with BSI. SAE was performed in 74 (13.3%) of the 557 (78%) NOM patients. The overall complication rate was 33.8%. Major complications occurred in 11 patients (14.9%) and minor in 13 patients (18.9%). There was no association between complications and coil location by logistic regression. Conclusions SAE continues to be a useful adjunct in the NOM of BSI though complications continue to occur. Fewer minor complications were noted in the period studied compared to past similar studies.
Leigh syndrome is a neurodegenerative mitochondrial disorder of childhood characterized by symmetrical spongiform lesions in the brain. The clinical presentation of Leigh's syndrome can vary significantly. However, in the majority of cases, it usually presents as a progressive neurological disease involving motor and cognitive development. It is common to see signs and symptoms of the midbrain and brainstem involvement. Limited data are present on the brain processes occurring in Leigh's syndrome which can be attributed to fatal respiratory failure. Raised lactate levels in the blood and/or cerebrospinal fluid are noted. Magnetic resonance imaging (MRI) findings such as necrotic, symmetrical lesions in the BG/brain stem are helpful in arriving at the diagnosis of Leigh's syndrome. It's of utmost importance to determine whether fatal respiratory failure can be predicted based on clinical characteristics and findings on MRI. In our report, we presented 3 cases from rural India, including a 2-year-old male child presenting with UMN lesion signs, a 3-month-old female infant with delayed developmental milestones with lab results suggestive of Leigh's disease, and a 12-year-old female child with epistaxis and generalized weakness. As discussed above, all 3 cases presented differently with a variety of signs and symptoms and would have gone undiagnosed without the use of brain imaging. The study concluded with the impression that while MRI is essential to the initial diagnosis of Leigh's disease, MRI alone cannot be used to predict fatal respiratory failure in patients with Leigh's disease. In any dilemma regarding diagnosis even with MRI, molecular studies remain the gold standard.
Growth in the craft brewing industry has increased the demand for locally sourced malting barley (Hordeum vulgare L.) grain in the Eastern United States. However, most malting barley seeding rate recommendations are from the Northern Great Plains, the Pacific Northwest, and Western Canada. Therefore, seeding rate research was needed in the humid growing environment of the Eastern United States. The objective of this research was to identify the agronomic optimum seeding rate (AOSR) where grain yield is maximized, and identify the seeding rate that met or exceeded grain quality parameters. An experiment with five seeding rate treatments ranging from 1.9 to 6.2 million seeds ha–1 was established at eight site‐years in Ohio. Under normal growing conditions, the AOSR was 3.8–6.2 million seeds ha–1 (average 4.5 million seeds ha–1). When plants experienced winter injury, the AOSR was greater at 5.3–5.4 million seeds ha–1. Grain quality parameters of protein, germination, and deoxynivalenol all tended to improve with increasing seeding rate. Seeding rates of 4.5–4.7 million seeds ha–1 should maximize yield most years while meeting grain quality parameters. However, regions that experience winter temperatures <15°C without snow coverage should increase seeding rates due to increased chance of winter injury reducing plant stand. Malting barley seeding rates of 4.5–4.7 million seeds ha‐1 should maximize yield. Grain protein and deoxynivalenol decreased with increasing seeding rate. Grain plumpness increased with increasing seeding rate.
Brain slice culture (BSC) is a well-known three-dimensional model of the brain. In this study, we use organotypic slices for studying neuro-lymphatic physiology, to directly test the longstanding assumption that the brain is not a hospitable milieu for typical lymphatic vessels. An additional objective is to model fluid egress through brain perivascular space systems and to visualize potential cellular interactions among cells in the leptomeninges including alterations of cellular geometry and number of processes. Immortalized lymphatic rat cell lines were used to seed organotypic brain slices. The brain slice model was characterized by monitoring morphologies, growth rates, degree of apoptosis, and transport properties of brain slices with or without a lymphatic component. The model was then challenged with fibroblast co-cultures, as a control cell that is not normally found in the brain. Immortalized lymphatic cells penetrated the brain slices within 2–4 days. Typical cell morphology is spindly with bipolar and tripolar forms well represented. Significantly more indigo carmine marker passed through lymphatic seeded BSCs compared to arachnoid BSCs. Significantly more indigo carmine passed through brain slices co-cultured with fibroblast compared to lymphatic and arachnoid BSCs alone. We have developed an organotypic model in which lymphatic cells are able to interact with parenchymal cells in the cerebrum. Their presence appears to alter the small molecule transport ability of whole-brain slices. Lymphatic cells decreased dye transport in BSCs, possibly by altering the perivascular space. Given their direct contact with the CSF, they may affect convectional and diffusional processes. Our model shows that a decrease in lymphatic cell growth may reduce the brain slice’s transport capabilities.
Introduction Biliopancreatic diversion with duodenal switch (BPD-DS) has often been reserved for patients with BMI > 50 kg/m². We aim to assess the safety of BPD-DS in patients with morbid obesity (BMI ³35 kg/m² and < 50 kg/m²) using a 150-cm common channel (CC), 150-cm Roux limb, and 60-fr bougie. Methods A retrospective review was performed on patients with a BMI < 50 mg/k² who underwent a BPD-DS in 2016–2019 at a single institution. Limb lengths were measured with a laparoscopic instrument with minimal tension. Sleeve gastrectomy was created with 60-fr bougie. Variables were compared using paired t test, Chi-square analysis or repeated measures ANOVA where appropriate. Results Forty-five patients underwent BPD-DS. CC lengths and Roux limb lengths were 158 ± 20 cm and 154 ± 18 cm, respectively. Preoperative BMI was 44.9 ± 2.3 kg/m² and follow-up was 2.7 ± 1.4 years. One patient required reoperation for bleeding and died from multiorgan failure and delayed sleeve leak. There was 1 (2.2%) readmission for contained anastomotic leak and 2 ED visits (4.5%) within 30 days. There were no marginal ulcers, limb length revisions, or need for parental nutrition. Percent excess weight loss was 67.2 ± 19.7%. 88.9% (N = 8), 86.6% (N = 13), and 55.5% (N = 5) of patients had resolution or improvement of their diabetes mellitus type II, hypertension, and hyperlipidemia, respectively. 40% (N = 4) of patients had resolution of their gastroesophageal reflux disease (GERD) and 11.4% (N = 5) developed de novo GERD. 32% (N = 14) of patients had vitamin D deficiency and 25% (N = 11) experienced zinc deficiency. Conclusion BPD-DS may be considered in patients with BMI < 50 kg/m² with 150-cm CC, 150-cm Roux limb, and a 60-fr bougie sleeve gastrectomy. There was sustained weight loss and no protein calorie malnutrition, but Vitamin D and zinc deficiency remained a challenge. Careful patient selection and proper counseling of the risks and benefits are necessary. Graphical abstract
Tor is the most well-known anonymity network that protects the identity of both content providers and their clients against any tracking on the Internet. The previous research on Tor investigated either the security and privacy concerns or the information and hyperlink structure. However, there is still a lack of knowledge about the information leakage attributed to the links from Tor hidden services to the surface Web. This work addresses this gap by a broad evaluation on: (a) the network of links from Tor to the surface Web, (b) the vulnerability of Tor hidden services against the information leakage, (c) the changes in the overall hyperlink structure of Tor hidden services caused by linking to surface websites, and (d) the type of information and services provided by the domains with significant impact on Tor’s network. The results recover the dark-to-surface network as a single massive, connected component where over 90% of identified Tor hidden services have at least one link to the surface world. We also identify that Tor directories significantly contribute to both communication and information dissemination through the network. Our study is the product of crawling approximately 2 million pages from 23,145 onion seed addresses, over a three-month period.
Purpose Literature on outcomes after SSRF, stratified for rib fracture pattern is scarce in patients with moderate to severe traumatic brain injury (TBI; Glasgow Coma Scale ≤ 12). We hypothesized that SSRF is associated with improved outcomes as compared to nonoperative management without hampering neurological recovery in these patients. Methods A post hoc subgroup analysis of the multicenter, retrospective CWIS-TBI study was performed in patients with TBI and stratified by having sustained a non-flail fracture pattern or flail chest between January 1, 2012 and July 31, 2019. The primary outcome was mechanical ventilation-free days and secondary outcomes were in-hospital outcomes. In multivariable analysis, outcomes were assessed, stratified for rib fracture pattern. Results In total, 449 patients were analyzed. In patients with a non-flail fracture pattern, 25 of 228 (11.0%) underwent SSRF and in patients with a flail chest, 86 of 221 (38.9%). In multivariable analysis, ventilator-free days were similar in both treatment groups. For patients with a non-flail fracture pattern, the odds of pneumonia were significantly lower after SSRF (odds ratio 0.29; 95% CI 0.11–0.77; p = 0.013). In patients with a flail chest, the ICU LOS was significantly shorter in the SSRF group (beta, − 2.96 days; 95% CI − 5.70 to − 0.23; p = 0.034). Conclusion In patients with TBI and a non-flail fracture pattern, SSRF was associated with a reduced pneumonia risk. In patients with TBI and a flail chest, a shorter ICU LOS was observed in the SSRF group. In both groups, SSRF was safe and did not hamper neurological recovery.
Gear crack evolution is a complex process; therefore, fault diagnosis and monitoring can help to avoid catastrophic accidents. In view of the deficiency that the simple linear plane assumption is made in the conventional crack model, the 3D spatial varying crack evolution (propagating in the depth, tooth width and tooth profile directions simultaneously) is investigated based on the linear elastic fracture mechanics in this study. The acquired crack morphology is used to analyse the time-varying meshing stiffness variation. Then, a system level rigid-flexible coupling model consisting of a housing, gear, shaft, and bearing is utilized to predict the dynamic response, and the theoretical results are compared with the experimental results. Furthermore, crack evolution-induced vibration detection is carried out by the proposed model, and the frequency spectrum characteristic, statistical indicator and instantaneous energy are obtained. The results reveal that the vibration impact is less obvious at the initial stage of crack evolution, but the instantaneous energy can amplify and capture the fault feature. Decreasing the housing stiffness can decrease the vibration impact induced by crack evolution; nevertheless, it increases the difficulty of crack detection.
The effect of cyclic shear deformation on structural relaxation and yielding in binary glasses was examined using molecular dynamics simulations. We studied a binary mixture slowly cooled from the liquid phase to about half the glass transition temperature and then periodically deformed at small strain amplitudes during thousands of cycles. We found that the potential energy decays logarithmically upon increasing number of cycles. The analysis of nonaffine displacements revealed that the process of mechanical annealing proceeds via intermittent plastic rearrangements whose spatial extent decreases upon reaching lower energy states. We also probed the yielding behavior for glasses with different degrees of annealing by adjusting strain amplitude near the critical value. Interestingly, in contrast to zero-temperature amorphous solids, the critical strain amplitude remains unchanged for glasses with initially different energy levels. The formation of a shear band at the yielding transition correlates well with the sharp increase of the number of atoms with large nonaffine displacements.
Compersion refers to the positive feelings, such as joy, excitement and contentment, that one may experience in response to one’s partner’s other consensually non-monogamous (CNM) intimate relationship(s). In the study, we recruited 44 CNM participants who had experienced compersion to complete an open-ended online survey regarding the factors that facilitated and hindered their experiences of compersion. A thematic analysis identified three main themes: intrapersonal/individual factors, experiences in and characteristics of the relationship with one’s partner(s), and feelings/judgments about one’s metamour (one’s partner’s partner). The factors most commonly named by participants as facilitating compersion included: feelings of self-worth, feeling secure and that one’s needs were being met in the relationship with the partner, communication with one’s partner, and positive regard for one’s metamour. Participants shared conflicting experiences regarding the nature of the relationship between jealousy and compersion and whether the ability to feel compersion was innate or learned. Findings were generally consistent with the small body of literature on this phenomenon. Several theories, including Broaden-and-Build, Self-Expansion, and Crossover, may help us understand the underpinnings of compersion and the pathways through which the experience might strengthen and deepen relationships. The study’s results suggest multiple hypotheses ripe for future testing. Increasing our knowledge of this little known phenomenon carries the potential to help us identify strategies to manage jealousy and increase positive feelings across all relationship types.
Materials with electromagnetic interference (EMI) shielding capabilities are crucial to reduce electromagnetic radiation pollution. This study investigates the EMI shielding and the dielectric properties of epoxy-based nanocomposites incorporating graphene nanoplatelets (GNPs) of varying surface area (750, 500 and 300 m²/g). Sonication during preparation and casting play significant roles in exfoliating and uniformly dispersing the GNPs in the epoxy matrix. EMI shielding properties are measured using the reflection–transmission method in the X-band frequency range, and dielectric properties are calculated using the Nicolson–Ross–Weir method. Complex permittivity, AC conductivity and EMI shielding performance increase with increasing GNP surface area and concentration, with maximum increase in properties over neat epoxy at 17 wt% 750 m²/g GNPs. The dominant observed shielding mechanism is reflection. However, at higher concentrations of the 750 m²/g GNPs, the material acts as a lossy medium with increasing absorptivity. The formation of conductive networks and interfacial polarization play a significant role in enhancing the real and imaginary parts of the permittivity and shielding performance.
Background: In the United States, the prevalence of opioid use disorders has increased in recent years along with an attendant rise in the incidence of chronic pain disorders and prescription opioid use. Patient navigation services have been used to improve health outcomes in cancer and other chronic disease states, but it is unclear whether the implementation of patient navigation services can facilitate improved outcomes among patients receiving chronic opioid therapy. Objectives: The objective of this study was to compare the outcomes of patients receiving chronic opioid therapy plus patient navigation services and those receiving chronic opioid therapy as a part of usual care. Study design: This was a prospective, observational study. Consecutive patients receiving chronic opioid therapy were enrolled, with alternating assignments to patient navigation (n = 30) or usual care (n = 30). Participants in the patient navigation group received support from a non-physician, non-advanced practice provider staff member who initiated frequent contact via telephone, telemedicine, or in-clinic visits to discuss the patient's health goals. The minimum follow-up period was 90 days. Outcomes qualitatively compared across groups included final pain score, final morphine milligram equivalent (MME) per day, and discharge rates. Risk factors for discharge within the navigation group were assessed. Patient feedback was also solicited. Setting: This study was conducted at a single independent pain clinic in the United States. Results: Demographic features were similar between the navigator group and the control group. The control group had a higher average initial pain score (7.0/10) than the intervention group (5.9/10) and were receiving a higher initial dose of opioids (23.1 vs 19.0 MME/d). After an average follow-up of 108.7 days, patients in the navigator group had a 16% decrease in final opioid dose compared with a 23% increase in the control group. Furthermore, patients in the control group were discharged from the practice at a higher rate (23.3% vs 6.6%), suggesting increased opioid misuse in the control group compared with the navigator group. In the navigator group, higher levels of anxiety and depression were the primary predictors of discharge. Limitations: This was a single-center study with a small sample size. The generalizability of these results to other clinic settings is unknown. Conclusions: Patient navigation decreased opioid use and practice discharge compared with usual care in an independent pain clinic, suggesting a role for patient navigation in reducing opioid misuse and potentially reducing adverse events.
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