Large-area vertically aligned 2D MoS2layers on TEMPO-cellulose nanofibers for biodegradable transient gas sensors.

Crystallographically anisotropic two-dimensional (2D) molybdenum disulfide (MoS2) with vertically aligned (VA) layers is attractive for electrochemical sensing owing to its surface-enriched dangling bonds coupled with extremely large mechanical deformability. In this study, we explored VA-2D MoS2layers integrated on cellulose nanofibers (CNFs) for detecting various volatile organic compound gases. Sensor devices employing VA-2D MoS2/CNFs exhibited excellent sensitivities for the tested gases of ethanol, methanol, ammonia, and acetone; e.g. a high response rate up to 83.39% for 100 ppm ethanol, significantly outperforming previously reported sensors employing horizontally aligned 2D MoS2layers. Furthermore, VA-2D MoS2/CNFs were identified to be completely dissolvable in buffer solutions such as phosphate-buffered saline solution and baking soda buffer solution without releasing toxic chemicals. This unusual combination of high sensitivity and excellent biodegradability inherent to VA-2D MoS2/CNFs offers unprecedented opportunities for exploring mechanically reconfigurable sensor technologies with bio-compatible transient characteristics.

Reconstruction of Distal Nasal Defects Using Free Cartilage Batten Grafting With Secondary Intention Healing: A Retrospective Case Series of 129 Patients.

BACKGROUND: Surgical defects of the distal nose can pose significant reconstructive challenges. Free cartilage batten graft (FCBG) with secondary intention healing is an underreported yet effective repair option with cosmetically and functionally satisfying outcomes. OBJECTIVE: To share the authors' experience using FCBG with secondary intention healing on multiple nasal subunits, including a detailed evaluation of wound/graft characteristics and design modifications to optimize success with this single-stage approach. METHODS: A retrospective study of 129 patients who underwent FCBG with secondary intention healing after Mohs surgery from 2011 to 2018, using statistical analysis of numerous outcome measures graded independently by 2 fellowship-trained Mohs surgeons. RESULTS: Overall, healed wounds were graded aesthetically as follows: excellent (24%), very good (31%), good (31%), or poor (14%). Excellent/very good outcomes were seen for superficial (p < .001), small-to-medium sized wounds (p < .0001) repaired with cartilage that closely approximated the defect size (p < .05). Consistently optimal outcomes were seen in the 19 repairs involving the alar lobule (mid-ala) alone, graded excellent (47%), very good (32%), and good (21%). A majority of patients (86%) experienced mild to no alar retraction. Although 67% of all patients had some skin surface contour irregularity, only 8% of patients sought dermabrasion. Neither hematoma, infection, ear deformity, chondritis, nor graft desiccation were reported. CONCLUSION: A modified approach to FCBG with secondary intention healing provides a reliable, minimalistic, low-risk reconstructive option for mid-alar defects.

Pediatric melanoma in the Hispanic population: An analysis of institutional and national data.

BACKGROUND/OBJECTIVES: Pediatric melanoma is rare and remains poorly characterized, especially in racial/ethnic minorities of whom Hispanics are the largest and fastest growing in the United States. The health care burden of melanoma in Hispanics, who often present with more advanced disease, is rising and has even been called an early epidemic in California. We sought to document key clinicopathologic features of melanoma in Hispanic pediatric patients and to compare these parameters to pediatric non-Hispanic whites (NHWs) under the a priori hypothesis that Spitzoid melanomas occur in greater proportions in Hispanics. METHODS: Single-institution cross-sectional study of pediatric melanoma cases (age < 20 years) with Hispanic stratification and comparison with matched Surveillance, Epidemiology, and End Results (SEER) data from the same time frame (1988-2016). RESULTS: Of our 61 institutional cases of pediatric melanoma, Hispanics (11), compared with NHWs (40), presented significantly younger (11.7 years, 95% CI: 2.77-8.00 years; P = .001), with lower limb predominance (46%; P < .05), mostly Spitzoid melanomas (82%; P < .05), and thicker tumors (2.34 mm, CI: 0.26-2.19 mm; P < .05). Similarly, SEER data (2499 cases) showed greater proportions of childhood/pre-pubertal adolescent melanomas (<15 years), lower limb involvement, Spitzoid subtype (36.5% vs 22.5% in NHWs; P = .001), and advanced (regional/distant) disease stages in Hispanics (212) compared with NHWs (2197). CONCLUSIONS: Pediatric melanomas may present differently in Hispanics, and heightened awareness/lower threshold to biopsy high-risk Spitzoid tumors on the lower limb may be warranted. Further investigations are needed to aid prevention and early detection in a vulnerable minority population less likely to seek outpatient dermatology specialty care.

Rice Husk-Derived Cellulose Nanofibers: A Potential Sensor for Water-Soluble Gases.

Cellulose and its derivatives have evoked much attention in sensor technology as host-matrices for conducting materials because of their versatility, renewability, and biocompatibility. However, only a few studies have dealt with the potential utilization of cellulose as a sensing material without a composite structure. In this study, cellulose nanofibers (CNF) and 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO)-oxidized cellulose nanofibers (TOCNF) extracted from rice husks by using ultrasonic-assisted methods are introduced as a potential gas sensing material with highly sensitive performance. To fabricate nanocellulose-based films, CNF, TOCNF, and TOCNF with glycerol (TOCNF/G) were dispersed in water and applied on polyimide substrate with digital electrodes to form self-standing thin films by a drop-casting method. A transparent coating layer on the surface of the plate after drying is used for the detection of water-soluble gases such as acetone, ammonia, methane, and hydrogen sulfide gases at room temperature at 52% relative humidity. The sensor prototypes exhibited high sensitivity, and the detection limit was between 1 ppm and 5 ppm, with less than 10 min response and recovery time. The results indicate that both the CNF- and the TOCNF-coated sensors show good sensitivity toward ammonia and acetone, compared to other gases. A TOCNF/G-coated sensor exhibited minimum time in regard to response/recovery time, compared to a CNF-coated sensor. In this study, nanocellulose-based sensors were successfully fabricated using a low-cost process and a bio-based platform. They showed good sensitivity for the detection of various gases under ambient conditions. Therefore, our study results should further propel in-depth research regarding various applications of cellulose-based sensors in the future.

Electromechanical Response of Smart Ultra-High Performance Concrete under External Loads Corresponding to Different Electrical Measurements.

This study investigated the electromechanical response of smart ultra-high-performance concretes (smart UHPCs), containing fine steel slag aggregates (FSSAs) and steel fibers as functional fillers, under external loads corresponding to different measurement methods. Regardless of different measurement methods of electrical resistance, the smart UHPCs under compression showed a clear reduction in their electrical resistivity. However, under tension, their electrical resistivity measured from direct current (DC) measurement decreased, whereas that from alternating current (AC) measurement increased. This was because the electrical resistivity, from DC measurement, of smart UHPCs was primarily dependent on fiber crack bridging, whereas that from AC measurement was dependent on tunneling effects.

An Innovative Smart Concrete Anchorage with Self-Stress Sensing Capacity of Prestressing Stress of PS Tendon.

An innovative smart concrete anchorage (SCA) has been developed for monitoring the stress of prestressing (PS) tendons by utilizing smart ultra-high-performance concrete (UHPC). The smart UHPC contained 2 vol% steel fibers and fine steel slag aggregates instead of silica sands. The effects of different electrode materials, arrangements, and connectors on the self-stress sensing capacity of the SCA are discussed. A prototype SCA demonstrated its feasibility and sufficient self-stress sensing capacity to be used in monitoring the prestressing loss of the PS tendon. As the tensile stress of the PS tendon increased from 0 to 1488 MPa, the fractional change in resistivity (FCR) of the prototype SCA, with horizontally paired copper wire electrodes and a plug-in type connector, decreased linearly from 0% to -1.53%, whereas the FCR increased linearly from -1.53% to -0.04% as the tensile stress of the PS tendon decreased from 1488 to 331 MPa.

Development of Low-Cost Wireless Sensing System for Smart Ultra-High Performance Concrete.

This study proposes the development of a wireless sensor system integrated with smart ultra-high performance concrete (UHPC) for sensing and transmitting changes in stress and damage occurrence in real-time. The smart UHPC, which has the self-sensing ability, comprises steel fibers, fine steel slag aggregates (FSSAs), and multiwall carbon nanotubes (MWCNTs) as functional fillers. The proposed wireless sensing system used a low-cost microcontroller unit (MCU) and two-probe resistance sensing circuit to capture change in electrical resistance of self-sensing UHPC due to external stress. For wireless transmission, the developed wireless sensing system used Bluetooth low energy (BLE) beacon for low-power and multi-channel data transmission. For experimental validation of the proposed smart UHPC, two types of specimens for tensile and compression tests were fabricated. In the laboratory test, using a universal testing machine, the change in electrical resistivity was measured and compared with a reference DC resistance meter. The proposed wireless sensing system showed decreased electrical resistance under compressive and tensile load. The fractional change in resistivity (FCR) was monitored at 39.2% under the maximum compressive stress and 12.35% per crack under the maximum compressive stress tension. The electrical resistance changes in both compression and tension showed similar behavior, measured by a DC meter and validated the developed integration of wireless sensing system and smart UHPC.

Multi-Domain Convolutional Neural Networks for Lower-Limb Motor Imagery Using Dry vs. Wet Electrodes.

Motor imagery (MI) brain-computer interfaces (BCIs) have been used for a wide variety of applications due to their intuitive matching between the user's intentions and the performance of tasks. Applying dry electroencephalography (EEG) electrodes to MI BCI applications can resolve many constraints and achieve practicality. In this study, we propose a multi-domain convolutional neural networks (MD-CNN) model that learns subject-specific and electrode-dependent EEG features using a multi-domain structure to improve the classification accuracy of dry electrode MI BCIs. The proposed MD-CNN model is composed of learning layers for three domain representations (time, spatial, and phase). We first evaluated the proposed MD-CNN model using a public dataset to confirm 78.96% classification accuracy for multi-class classification (chance level accuracy: 30%). After that, 10 healthy subjects participated and performed three classes of MI tasks related to lower-limb movement (gait, sitting down, and resting) over two sessions (dry and wet electrodes). Consequently, the proposed MD-CNN model achieved the highest classification accuracy (dry: 58.44%; wet: 58.66%; chance level accuracy: 43.33%) with a three-class classifier and the lowest difference in accuracy between the two electrode types (0.22%, d = 0.0292) compared with the conventional classifiers (FBCSP, EEGNet, ShallowConvNet, and DeepConvNet) that used only a single domain. We expect that the proposed MD-CNN model could be applied for developing robust MI BCI systems with dry electrodes.

SSVM: An Ultra-Low-Power Strain Sensing and Visualization Module for Long-Term Structural Health Monitoring.

Structural health monitoring (SHM) is crucial for quantitative behavioral analysis of structural members such as fatigue, buckling, and crack propagation identification. However, formerly developed approaches cannot be implemented effectively for long-term infrastructure monitoring, owing to power inefficiency and data management challenges. This study presents the development of a high-fidelity and ultra-low-power strain sensing and visualization module (SSVM), along with an effective data management technique. Deployment of 24-bit resolution analog to a digital converter and precise half-bridge circuit for strain sensing are two significant factors for efficient strain measurement and power management circuit incorporating a low-power microcontroller unit (MCU), and electronic-paper display (EPD) enabled long-term operation. A prototype for SSVM was developed that performs strain sensing and encodes the strain response in a QR code for visualization on the EPD. For efficient power management, SSVM only activated when the trigger-signal was generated and stayed in power-saving mode consuming 18 mA and 337.9 µA, respectively. The trigger-signal was designed to be generated either periodically by a timer or intentionally by a push-button. A smartphone application and cloud database were developed for efficient data acquisition and management. A lab-scale experiment was carried out to validate the proposed system with a reference strain sensing system. A cantilever beam was deflected by increasing load at its free end, and the resultant strain response of SSVM was compared with the reference. The proposed system was successfully validated to use for long-term static strain measurement.

Ergonomics in Dermatologic Surgery: Lessons Learned Across Related Specialties and Opportunities for Improvement.

BACKGROUND: As the practice of dermatology becomes increasingly procedurally based, there is a concordant rise in musculoskeletal injury (MSI) risk. Dermatologic surgeons are most susceptible and, although the majority suffer from MSI, few have received any formal ergonomics training. This stems from a lack of awareness of this troubling trend and a paucity of research and education on the ergonomics of dermatologic surgery. OBJECTIVE: To highlight pertinent ergonomics principles and strategies from other specialties that could be translated into dermatology, and to synthesize general recommendations aimed at reducing MSI among dermatologic surgeons. MATERIALS AND METHODS: A comprehensive search of the PubMed and Cochrane Reviews databases from 1975 to 2019 was conducted, using a combination of ergonomics-related search terms, generating 6 publications from the dermatology literature and 58 from the fields of dentistry, medicine, and select surgical subspecialties. RESULTS: This multidisciplinary approach yielded multiple interventions that could be applied directly (i.e., adequate lighting, adjustable operating tables, and surgical seat heights) or indirectly pending further investigation into their feasibility (i.e., video displays of the surgical field to allow neutral head and neck postures). CONCLUSION: Although much can be learned from decades of prior ergonomics research from other specialties, considerations that are unique to dermatology remain and must be addressed with specialty-specific research.

Comparative Performance of Four Electrodes for Measuring the Electromechanical Response of Self-Damage Detecting Concrete under Tensile Load.

Self-damage or/and stress-sensing concrete is a promising area of research for measuring the electromechanical response of structural materials using more robust sensors. However, the copper and silver paste sensors widely used in such applications can be expensive and have detrimental effects on the load carrying capacity and durability of the structural systems upon which they are installed. Accordingly, this study compared the performance of four electrode types-conventional copper tape with silver paste (CS), copper film with type 1 carbon tape (CC1), copper film with type 2 carbon tape (CC2), and copper wire and film with type 2 carbon tape (WC2)-to develop an economical and practical electrode for measuring the electromechanical response of self-damage-detecting concrete. The CC1 electrode exhibited comparable performance to the CS electrode in measuring the electromechanical response of self-damage-detecting concrete, despite requiring a longer polarization time (80 s) than the CS electrode (25 s). The CS electrode exhibited a higher damage-sensing capacity (GF2), whereas the CC1 electrode exhibited a higher strain-sensing capacity (GF1), as well as good damage-sensing capacity. Therefore, the CC1 electrode using copper film with type 1 carbon tape was determined to be the best alternative to the conventional CS electrode.

Mathematical Modelling of CSF Pulsatile Flow in Aqueduct Cerebri.

OBJECTIVE: The phase-contrast MRI technique permits the non-invasive assessment of CSF movements in cerebrospinal fluid cavities of the central nervous system. Of particular interest is pulsatile cerebrospinal fluid (CSF) flow through the aqueduct cerebri. It is allegedly increased in hydrocephalus, having potential diagnostic value, although not all scientific reports contain unequivocally positive conclusions. METHODS: For the mathematical simulation of CSF flow, we used a computational model of cerebrospinal blood/fluid circulation designed by a former student as his PhD project. With this model, cerebral blood flow and CSF may be simulated in various vessels using a system of non-linear differential equations as time-varying signals. RESULTS: The amplitude of CSF flow seems to be positively related to the amplitude of pulse waveforms of intracranial pressure (ICP) in situations where mean ICP increases, such as during simulated infusion tests and following step increases of resistance to CSF outflow. An additional positive association between the pulse amplitude of ICP and CSF flow can be seen during simulated increases in the amplitude of arterial pulses (without changes in mean arterial pressure, MAP). The opposite effect can be observed during step increases in the resistance of the aqueduct cerebri and with decreasing elasticity of the system, where the CSF flow amplitude and the ICP pulse amplitude are related inversely. Vasodilatation caused by both gradual decreases in MAP and by increases in PaCO2 provokes an elevation in the observed amplitude of pulsatile CSF flow. CONCLUSIONS: Preliminary results indicate that the pulsations of CSF flow may carry information about both CSF-circulatory and cerebral vasogenic components. In most cases, the pulsations of CSF flow are positively related to the pulse amplitudes of both arterial pressure and ICP and to a degree of cerebrovascular dilatation.

Impaired cerebral compensatory reserve is associated with admission imaging characteristics of diffuse insult in traumatic brain injury.

BACKGROUND: Continuous assessment of cerebral compensatory reserve is possible using the moving correlation between pulse amplitude of intra-cranial pressure (AMP) and intra-cranial pressure (ICP), called RAP. Little is known about the behavior and associations of this index in adult traumatic brain injury (TBI). The goal of this study is to evaluate the association between admission cerebral imaging findings and RAP over the course of the acute intensive care unit stay. METHODS: We retrospectively reviewed 358 adult TBI patients admitted to the Addenbrooke's Hospital, University of Cambridge, from March 2005 to December 2016. Only non-craniectomy patients were studied. Using archived high frequency physiologic signals, RAP was derived and analyzed over the first 48 h and first 10 days of recording in each patient, using grand mean, percentage of time above various thresholds, and integrated area under the curve (AUC) of RAP over time. Associations between these values and admission computed tomography (CT) injury characteristics were evaluated. RESULTS: The integrated AUC, based on various thresholds of RAP, was statistically associated with admission CT markers of diffuse TBI and cerebral edema. Admission CT findings of cortical gyral effacement, lateral ventricle compression, diffuse cortical subarachnoid hemorrhage (SAH), thickness of cortical SAH, presence of bilateral contusions, and subcortical diffuse axonal injury (DAI) were all associated with AUC of RAP over time. Joncheere-Terpstra testing indicated a statistically significant increase in mean RAP AUC across ordinal categories of the abovementioned associated CT findings. CONCLUSIONS: RAP is associated with cerebral CT injury patterns of diffuse injury and edema, providing some confirmation of its potential measurement of cerebral compensatory reserve in TBI.

Validation of Davson's equation in patients suffering from idiopathic normal pressure hydrocephalus.

INTRODUCTION: The so-called Davson's equation relates baseline intracranial pressure (ICP) to resistance to cerebrospinal fluid outflow (Rout), formation of cerebrospinal fluid (If) and sagittal sinus pressure (PSS) There is a controversy over whether this fundamental equation is applicable in patients with normal pressure hydrocephalus (NPH). We investigated the relationship between Rout and ICP and also other compensatory, clinical and demographic parameters in NPH patients. METHOD: We carried out a retrospective study of 229 patients with primary NPH who had undergone constant-rate infusion studies in our hospital. Data was recorded and processed using ICM+ software. Relationships between variables were sought by calculating Pearson product correlation coefficients and p values. RESULTS: We found a significant, albeit weak, relationship between ICP and Rout (R = 0.17, p = 0.0049), Rout and peak-to-peak amplitude of ICP (AMP) (R = 0.27, p = 3.577e-05) and Rout and age (R = 0.16, p = 0.01306). CONCLUSIONS: The relationship found between ICP and Rout provides indirect evidence to support disturbed Cerebrospinal fluid circulation as a key factor in disturbed CSF dynamics in NPH. Weak correlation may indicate that other factors-variable PSS and formation of CSF outflow-contribute heavily to linear model expressed by Davson's equation.

Enhanced Gas-Sensing Performance of GO/TiO2 Composite by Photocatalysis.

Few studies have investigated the gas-sensing properties of graphene oxide/titanium dioxide (GO/TiO2) composite combined with photocatalytic effect. Room temperature gas-sensing properties of the GO/TiO2 composite were investigated towards various reducing gases. The composite sensor showed an enhanced gas response and a faster recovery time than a pure GO sensor due to the synergistic effect of the hybridization, such as creation of a hetero-junction at the interface and modulation of charge carrier density. However, the issue of long-term stability at room temperature still remains unsolved even after construction of a composite structure. To address this issue, the surface and hetero-junction of the GO/TiO2 composite were engineered via a UV process. A photocatalytic effect of TiO2 induced the reduction of the GO phase in the composite solution. The comparison of gas-sensing properties before and after the UV process clearly showed the transition from n-type to p-type gas-sensing behavior toward reducing gases. This transition revealed that the dominant sensing material is GO, and TiO2 enhanced the gas reaction by providing more reactive sites. With a UV-treated composite sensor, the function of identifying target gas was maintained over a one-month period, showing strong resistance to humidity.

Cerebrovascular pressure reactivity monitoring using wavelet analysis in traumatic brain injury patients: A retrospective study.

BACKGROUND: After traumatic brain injury (TBI), the ability of cerebral vessels to appropriately react to changes in arterial blood pressure (pressure reactivity) is impaired, leaving patients vulnerable to cerebral hypo- or hyperperfusion. Although, the traditional pressure reactivity index (PRx) has demonstrated that impaired pressure reactivity is associated with poor patient outcome, PRx is sometimes erratic and may not be reliable in various clinical circumstances. Here, we introduce a more robust transform-based wavelet pressure reactivity index (wPRx) and compare its performance with the widely used traditional PRx across 3 areas: its stability and reliability in time, its ability to give an optimal cerebral perfusion pressure (CPPopt) recommendation, and its relationship with patient outcome. METHODS AND FINDINGS: Five hundred and fifteen patients with TBI admitted in Addenbrooke's Hospital, United Kingdom (March 23rd, 2003 through December 9th, 2014), with continuous monitoring of arterial blood pressure (ABP) and intracranial pressure (ICP), were retrospectively analyzed to calculate the traditional PRx and a novel wavelet transform-based wPRx. wPRx was calculated by taking the cosine of the wavelet transform phase-shift between ABP and ICP. A time trend of CPPopt was calculated using an automated curve-fitting method that determined the cerebral perfusion pressure (CPP) at which the pressure reactivity (PRx or wPRx) was most efficient (CPPopt_PRx and CPPopt_wPRx, respectively). There was a significantly positive relationship between PRx and wPRx (r = 0.73), and wavelet wPRx was more reliable in time (ratio of between-hour variance to total variance, wPRx 0.957 ± 0.0032 versus PRx and 0.949 ± 0.047 for PRx, p = 0.002). The 2-hour interval standard deviation of wPRx (0.19 ± 0.07) was smaller than that of PRx (0.30 ± 0.13, p < 0.001). wPRx performed better in distinguishing between mortality and survival (the area under the receiver operating characteristic [ROC] curve [AUROC] for wPRx was 0.73 versus 0.66 for PRx, p = 0.003). The mean difference between the patients' CPP and their CPPopt was related to outcome for both calculation methods. There was a good relationship between the 2 CPPopts (r = 0.814, p < 0.001). CPPopt_wPRx was more stable than CPPopt_PRx (within patient standard deviation 7.05 ± 3.78 versus 8.45 ± 2.90; p < 0.001). Key limitations include that this study is a retrospective analysis and only compared wPRx with PRx in the cohort of patients with TBI. Prior prospective validation is required to better assess clinical utility of this approach. CONCLUSIONS: wPRx offers several advantages to the traditional PRx: it is more stable in time, it yields a more consistent CPPopt recommendation, and, importantly, it has a stronger relationship with patient outcome. The clinical utility of wPRx should be explored in prospective studies of critically injured neurological patients.

An Association Between ICP-Derived Data and Outcome in TBI Patients: The Role of Sample Size.

BACKGROUND: Many demographic and physiological variables have been associated with TBI outcomes. However, with small sample sizes, making spurious inferences is possible. This paper explores the effect of sample sizes on statistical relationships between patient variables (both physiological and demographic) and outcome. METHODS: Data from head-injured patients with monitored arterial blood pressure, intracranial pressure (ICP) and outcome assessed at 6 months were included in this retrospective analysis. A univariate logistic regression analysis was performed to obtain the odds ratio for unfavorable outcome. Three different dichotomizations between favorable and unfavorable outcomes were considered. A bootstrap method was implemented to estimate the minimum sample sizes needed to obtain reliable association between physiological and demographic variables with outcome. RESULTS: In a univariate analysis with dichotomized outcome, samples sizes should be generally larger than 100 for reproducible results. Pressure reactivity index, ICP, and ICP slow waves offered the strongest relationship with outcome. Relatively small sample sizes may overestimate effect sizes or even produce conflicting results. CONCLUSION: Low power tests, generally achieved with small sample sizes, may produce misleading conclusions, especially when they are based only on p values and the dichotomized criteria of rejecting/not-rejecting the null hypothesis. We recommend reporting confidence intervals and effect sizes in a more complete and contextualized data analysis.

Finite Element Model for Hydrocephalus and Idiopathic Intracranial Hypertension.

Hydrocephalus and idiopathic intracranial hypertension (IIH) are neuropathies associated with disturbed cerebrospinal fluid dynamics. Several finite element (FE) brain models were suggested to simulate the pathological changes in hydrocephalus, but with overly simplified assumptions regarding the properties of the brain parenchyma. This study proposes a two-dimensional FE brain model, capable of simulating both hydrocephalus and IIH by incorporating poro-hyperelasticity of the brain and detailed structural information (i.e., sulci).