The Effect of Laser-Resistant Endotracheal Tube Design on Airflow Dynamics: A Benchtop and Clinical Study.

OBJECTIVE: Compare ventilation pressures of 2 endotracheal tube designs used in laser airway surgery in clinical practice and with a benchtop model to elucidate differences and understand the design elements that impact airflow dynamics. METHODS: Ventilatory and aerodynamic characteristics of the laser resistant stainless-steel endotracheal tube (LRSS-ET) design and the laser resistant aluminum-wrapped silicone endotracheal tube (LRAS-ET) design were compared. Ventilatory parameters were collected for 32 patients undergoing laser-assisted airway surgery through retrospective chart review. An in vitro benchtop simulation measured average resistance and centerline turbulence intensity of both designs at various diameters and physiological frequencies. RESULTS: Baseline patient characteristics did not differ between the 2 groups. Clinically, the median LRAS-ET peak inspiratory pressure (PIP; 21.00 cm H2O) was significantly decreased compared to LRSS-ET PIP (34.67 cm H2O). In benchtop simulation, the average PIP of the LRAS-ET was significantly lower at all sizes and frequencies. The LRSS-ET consistently demonstrated an increased resistance, although no patterns were observed in turbulence intensity data between both designs. CONCLUSION: The benchtop model demonstrated increased resistance in the LRSS-ET compared to the LRAS-ET at all comparable sizes. This finding is supported by retrospective ventilatory pressures during laser airway surgery, which show significantly increased PIPs when comparing identically sized inner diameters. Given the equivocal turbulence intensity data, these differences in resistance and pressures are likely caused by wall roughness and intraluminal presence of tubing, not inlet or outlet geometries. The decreased PIPs of the LRAS-ET should assist in following lung protective ventilator management strategies and reduce risk of pulmonary injury and hemodynamic instability to the patient.

Late-season corn stalk nitrate measurements across the US Midwest from 2006 to 2018.

The late-season Corn Stalk Nitrate Test (CSNT) is a well-known tool to help evaluate the after-the-fact performance of nitrogen management. The CSNT has the unique ability to distinguish between optimal and excessive corn nitrogen status, which makes it helpful for identifying the over-application of N so that farmers can adjust their future nitrogen decisions. This paper presents a multi-year and multi-location dataset of late-season corn stalk nitrate test measurements across the US Midwest from 2006 to 2018. The dataset consists of 32,025 corn stalk nitrate measurements from 10,675 corn fields. The nitrogen form, total N rate applied, US state, year of harvest, and climatic conditions are included for each corn field. When available, previous crop, manure source, tillage, and timing of N application are also informed. We provide a detailed description of the dataset to make it usable by the scientific community. Data are published through an R package and also available at the USDA National Agricultural Library Ag Data Commons repository and through an interactive website.

Fine-tuning near-boundary swimming equilibria using asymmetric kinematics.

When swimming near a solid planar boundary, bio-inspired propulsors can naturally equilibrate to certain distances from that boundary. How these equilibria are affected by asymmetric swimming kinematics is unknown. We present here a study of near-boundary pitching hydrofoils based on water channel experiments and potential flow simulations. We found that asymmetric pitch kinematics do affect near-boundary equilibria, resulting in the equilibria shifting either closer to or away from the planar boundary. The magnitude of the shift depends on whether the pitch kinematics have spatial asymmetry (e.g. a bias angle,θ0) or temporal asymmetry (e.g. a stroke-speed ratio,τ). Swimming at stable equilibrium requires less active control, while shifting the equilibrium closer to the boundary can result in higher thrust with no measurable change in propulsive efficiency. Our work reveals how asymmetric kinematics could be used to fine-tune a hydrofoil's interaction with a nearby boundary, and it offers a starting point for understanding how fish and birds use asymmetries to swim near substrates, water surfaces, and sidewalls.

Towards breath sensors that are self-powered by design.

Piezoelectric materials are widely used to generate electric charge from mechanical deformation or vice versa. These strategies are increasingly common in implantable medical devices, where sensing must be done on small scales. In the case of a flow rate sensor, a sensor's energy harvesting rate could be mapped to that flow rate, making it 'self-powered by design (SPD)'. Prior fluids-based SPD work has focused on turbulence-driven resonance and has been largely empirical. Here, we explore the possibility of sub-resonant SPD flow sensing in a human airway. We present a physical model of piezoelectric sensing/harvesting in the airway, which we validated with a benchtop experiment. Our work offers a model-based roadmap for implantable SPD sensing solutions. We also use the model to theorize a new form of SPD sensing that can detect broadband flow information.

Capacitive Sensing for Monitoring Stent Patency in the Central Airway.

Central airway obstruction (CAO) is a respiratory disorder characterized by the blockage of the trachea and/or the main bronchi that can be life-threatening. Airway stenting is a palliative procedure for CAO commonly used given its efficacy. However, mucus impaction, secretion retention, and granulation tissue growth are known complications that can counteract the stent's benefits. To prevent these situations, patients are routinely brought into the hospital to check stent patency, incurring a burden for the patient and the health care system, unnecessarily when no problems are found. In this paper, we introduce a capacitive sensor embedded in a stent that can detect solid and colloidal obstructions in the stent, as such obstructions alter the capacitor's dielectric relative permittivity. In the case of colloidal obstructions (e.g., mucus), volumes as low as 0.1 ml can be detected. Given the small form factor of the sensor, it could be adapted to a variety of stent types without changing the standard bronchoscopy insertion method. The proposed system is a step forward in the development of smart airway stents that overcome the limitations of current stenting technology.Clinical Relevance- This establishes the foundation for smart stent technology to monitor stent patency as an alternative to rutinary bronchoscopies.

Tunable stiffness in fish robotics: mechanisms and advantages.

One of the emerging themes of fish-inspired robotics is flexibility. Adding flexibility to the body, joints, or fins of fish-inspired robots can significantly improve thrust and/or efficiency during locomotion. However, the optimal stiffness depends on variables such as swimming speed, so there is no one 'best' stiffness that maximizes efficiency in all conditions. Fish are thought to solve this problem by using muscular activity to tune their body and fin stiffness in real-time. Inspired by fish, some recent robots sport polymer actuators, adjustable leaf springs, or artificial tendons that tune stiffness mechanically. Models and water channel tests are providing a theoretical framework for stiffness-tuning strategies that devices can implement. The strategies can be thought of as analogous to car transmissions, which allow users to improve efficiency by tuning gear ratio with driving speed. We provide an overview of the latest discoveries about (1) the propulsive benefits of flexibility, particularlytunableflexibility, and (2) the mechanisms and strategies that fish and fish-inspired robots use to tune stiffness while swimming.

Streamwise and lateral maneuvers of a fish-inspired hydrofoil.

Fish are highly maneuverable compared to human-made underwater vehicles. Maneuvers are inherently transient, so they are often studied via observations of fish and fish-like robots, where their dynamics cannot be recorded directly. To study maneuvers in isolation, we designed a new kind of wireless carriage whose air bushings allow a hydrofoil to maneuver semi-autonomously in a water channel. We show that modulating the hydrofoil's frequency, amplitude, pitch bias, and stroke speed ratio (pitching speed of left vs right stroke) produces streamwise and lateral maneuvers with mixed effectiveness. Modulating pitch bias, for example, produces quasi-steady lateral maneuvers with classic reverse von Kármán wakes, whereas modulating the stroke speed ratio produces sudden yaw torques and vortex pairs like those observed behind turning zebrafish. Our findings provide a new framework for considering in-plane maneuvers and streamwise/lateral trajectory corrections in fish and fish-inspired robots.

Comparing Models of Lateral Station-Keeping for Pitching Hydrofoils.

Fish must maneuver laterally to maintain their position in schools or near solid boundaries. Unsteady hydrodynamic models, such as the Theodorsen and Garrick models, predict forces on tethered oscillating hydrofoils aligned with the incoming flow. How well these models predict forces when bio-inspired hydrofoils are free to move laterally or when angled relative to the incoming flow is unclear. We tested the ability of five linear models to predict a small lateral adjustment made by a hydrofoil undergoing biased pitch oscillations. We compared the models to water channel tests in which air bushings gave a rigid pitching hydrofoil lateral freedom. What we found is that even with no fitted coefficients, linear models predict some features of the lateral response, particularly high frequency features like the amplitude and phase of passive heave oscillations. To predict low frequency features of the response, such as overshoot and settling time, we needed a semiempirical model based on tethered force measurements. Our results suggest that fish and fish-inspired vehicles could use linear models for some aspects of lateral station-keeping, but would need nonlinear or semiempirical wake models for more advanced maneuvers.

How lovebirds maneuver through lateral gusts with minimal visual information.

Flying birds maneuver effectively through lateral gusts, even when gust speeds are as high as flight speeds. What information birds use to sense gusts and how they compensate is largely unknown. We found that lovebirds can maneuver through 45° lateral gusts similarly well in forest-, lake-, and cave-like visual environments. Despite being diurnal and raised in captivity, the birds fly to their goal perch with only a dim point light source as a beacon, showing that they do not need optic flow or a visual horizon to maneuver. To accomplish this feat, lovebirds primarily yaw their bodies into the gust while fixating their head on the goal using neck angles of up to 30°. Our corroborated model for proportional yaw reorientation and speed control shows how lovebirds can compensate for lateral gusts informed by muscle proprioceptive cues from neck twist. The neck muscles not only stabilize the lovebirds' visual and inertial head orientations by compensating low-frequency body maneuvers, but also attenuate faster 3D wingbeat-induced perturbations. This head stabilization enables the vestibular system to sense the direction of gravity. Apparently, the visual horizon can be replaced by a gravitational horizon to inform the observed horizontal gust compensation maneuvers in the dark. Our scaling analysis shows how this minimal sensorimotor solution scales favorably for bigger birds, offering local wind angle feedback within a wingbeat. The way lovebirds glean wind orientation may thus inform minimal control algorithms that enable aerial robots to maneuver in similar windy and dark environments.

Surgical Treatment of Cubital Tunnel in Pediatric Athletes.

Background Cubital tunnel syndrome is the second most common upper extremity peripheral nerve entrapment syndrome. In particular, cubital tunnel has been documented occasionally in young, throwing athletes. Materials and Methods Billing databases were searched for patients undergoing surgical decompression of the ulnar nerve at the elbow, who were age 18 or younger at the time of surgery. Charts were reviewed and patients were included if they had an isolated mononeuropathy consistent with cubital tunnel syndrome and were symptomatic. Data on age of onset, duration of symptoms, Dellon classification, nerve subluxation, provocative testing results, nerve conductions, and exacerbating activities were abstracted. Patients were contacted for a postsurgical follow-up questionnaire. Results Seven patients were identified. The average age was 16, and duration of symptoms was 7 months. All seven patients had normal electrodiagnostic studies and had failed a course of conservative treatment. All were satisfied with surgery and felt improvement. One stopped playing their sport, and three had mild symptoms with varied activities. Conclusion Although uncommon, pediatric cubital tunnel syndrome does occur. Surgical release improves symptoms and return to activities. Nevertheless, some degree of symptoms often persists. Electrodiagnostic studies may be negative in many patients with an otherwise consistent history and examination. Level of Evidence This is a level IV therapeutic study.

Resurrection Biology: Aged Acetylcholinesterase Brought Back to Life.

Organophosphorus agents such as sarin and soman that phosphylate the active site serine of the enzyme acetylcholinesterase are notorious and pernicious, not only because they have been used by tyrants to effect mass murder of their own populations but also because they are sought by terrorists to inflict mass casualties on civilian populations. These threats underscore the need to develop effective antidotes against such agents. Phosphylation of acetylcholinesterase produces two adducts, an initial neutral adduct that can be reactivated with oxime nucleophiles, and a subsequent monoanionic adduct (called aged acetylcholinesterase) which has proven over two generations to be impervious to reactivation. This Viewpoint discusses a recent article in the journal that describes the first successful efforts to resurrect the activity of aged acetylcholinesterase.

Adaptive control of turbulence intensity is accelerated by frugal flow sampling.

The aerodynamic performance of vehicles and animals, as well as the productivity of turbines and energy harvesters, depends on the turbulence intensity of the incoming flow. Previous studies have pointed at the potential benefits of active closed-loop turbulence control. However, it is unclear what the minimal sensory and algorithmic requirements are for realizing this control. Here we show that very low-bandwidth anemometers record sufficient information for an adaptive control algorithm to converge quickly. Our online Newton-Raphson algorithm tunes the turbulence in a recirculating wind tunnel by taking readings from an anemometer in the test section. After starting at 9% turbulence intensity, the algorithm converges on values ranging from 10% to 45% in less than 12 iterations within 1% accuracy. By down-sampling our measurements, we show that very-low-bandwidth anemometers record sufficient information for convergence. Furthermore, down-sampling accelerates convergence by smoothing gradients in turbulence intensity. Our results explain why low-bandwidth anemometers in engineering and mechanoreceptors in biology may be sufficient for adaptive control of turbulence intensity. Finally, our analysis suggests that, if certain turbulent eddy sizes are more important to control than others, frugal adaptive control schemes can be particularly computationally effective for improving performance.

Protein Mass Effects on Formate Dehydrogenase.

Isotopically labeled enzymes (denoted as "heavy" or "Born-Oppenheimer" enzymes) have been used to test the role of protein dynamics in catalysis. The original idea was that the protein's higher mass would reduce the frequency of its normal-modes without altering its electrostatics. Heavy enzymes have been used to test if the vibrations in the native enzyme are coupled to the chemistry it catalyzes, and different studies have resulted in ambiguous findings. Here the temperature-dependence of intrinsic kinetic isotope effects of the enzyme formate dehydrogenase is used to examine the distribution of H-donor to H-acceptor distance as a function of the protein's mass. The protein dynamics are altered in the heavy enzyme to diminish motions that determine the transition state sampling in the native enzyme, in accordance with a Born-Oppenheimer-like effect on bond activation. Findings of this work suggest components related to fast frequencies that can be explained by Born-Oppenheimer enzyme hypothesis (vibrational) and also slower time scale events that are non-Born-Oppenheimer in nature (electrostatic), based on evaluations of protein mass dependence of donor-acceptor distance and forward commitment to catalysis along with steady state and single turnover measurements. Together, the findings suggest that the mass modulation affected both local, fast, protein vibrations associated with the catalyzed chemistry and the protein's macromolecular electrostatics at slower time scales; that is, both Born-Oppenheimer and non-Born-Oppenheimer effects are observed. Comparison to previous studies leads to the conclusion that isotopic labeling of the protein may have different effects on different systems, however, making heavy enzyme studies a very exciting technique for exploring the dynamics link to catalysis in proteins.

Why is Aged Acetylcholinesterase So Difficult to Reactivate?

Organophosphorus agents are potent inhibitors of acetylcholinesterase. Inhibition involves successive chemical events. The first is phosphylation of the active site serine to produce a neutral adduct, which is a close structural analog of the acylation transition state. This adduct is unreactive toward spontaneous hydrolysis, but in many cases can be reactivated by nucleophilic medicinal agents, such as oximes. However, the initial phosphylation reaction may be followed by a dealkylation reaction of the incipient adduct. This reaction is called aging and produces an anionic phosphyl adduct with acetylcholinesterase that is refractory to reactivation. This review considers why the anionic aged adduct is unreactive toward nucleophiles. An alternate approach is to realkylate the aged adduct, which would render the adduct reactivatable with oxime nucleophiles. However, this approach confronts a considerable-and perhaps intractable-challenge: the aged adduct is a close analog of the deacylation transition state. Consequently, the evolutionary mechanisms that have led to transition state stabilization in acetylcholinesterase catalysis are discussed herein, as are the challenges that they present to reactivation of aged acetylcholinesterase.

Flavin-dependent thymidylate synthase: N5 of flavin as a Methylene carrier.

Thymidylate is synthesized de novo in all living organisms for replication of genomes. The chemical transformation is reductive methylation of deoxyuridylate at C5 to form deoxythymidylate. All eukaryotes including humans complete this well-understood transformation with thymidylate synthase utilizing 6R-N5-N10-methylene-5,6,7,8-tetrahydrofolate as both a source of methylene and a reducing hydride. In 2002, flavin-dependent thymidylate synthase was discovered as a new pathway for de novo thymidylate synthesis. The flavin-dependent catalytic mechanism is different than thymidylate synthase because it requires flavin as a reducing agent and methylene transporter. This catalytic mechanism is not well-understood, but since it is known to be very different from thymidylate synthase, there is potential for mechanism-based inhibitors that can selectively inhibit the flavin-dependent enzyme to target many human pathogens with low host toxicity.

A new low-turbulence wind tunnel for animal and small vehicle flight experiments.

Our understanding of animal flight benefits greatly from specialized wind tunnels designed for flying animals. Existing facilities can simulate laminar flow during straight, ascending and descending flight, as well as at different altitudes. However, the atmosphere in which animals fly is even more complex. Flow can be laminar and quiet at high altitudes but highly turbulent near the ground, and gusts can rapidly change wind speed. To study flight in both laminar and turbulent environments, a multi-purpose wind tunnel for studying animal and small vehicle flight was built at Stanford University. The tunnel is closed-circuit and can produce airspeeds up to 50 m s-1 in a rectangular test section that is 1.0 m wide, 0.82 m tall and 1.73 m long. Seamless honeycomb and screens in the airline together with a carefully designed contraction reduce centreline turbulence intensities to less than or equal to 0.030% at all operating speeds. A large diameter fan and specialized acoustic treatment allow the tunnel to operate at low noise levels of 76.4 dB at 20 m s-1. To simulate high turbulence, an active turbulence grid can increase turbulence intensities up to 45%. Finally, an open jet configuration enables stereo high-speed fluoroscopy for studying musculoskeletal control in turbulent flow.

Lift calculations based on accepted wake models for animal flight are inconsistent and sensitive to vortex dynamics.

There are three common methods for calculating the lift generated by a flying animal based on the measured airflow in the wake. However, these methods might not be accurate according to computational and robot-based studies of flapping wings. Here we test this hypothesis for the first time for a slowly flying Pacific parrotlet in still air using stereo particle image velocimetry recorded at 1000 Hz. The bird was trained to fly between two perches through a laser sheet wearing laser safety goggles. We found that the wingtip vortices generated during mid-downstroke advected down and broke up quickly, contradicting the frozen turbulence hypothesis typically assumed in animal flight experiments. The quasi-steady lift at mid-downstroke was estimated based on the velocity field by applying the widely used Kutta-Joukowski theorem, vortex ring model, and actuator disk model. The calculated lift was found to be sensitive to the applied model and its different parameters, including vortex span and distance between the bird and laser sheet-rendering these three accepted ways of calculating weight support inconsistent. The three models predict different aerodynamic force values mid-downstroke compared to independent direct measurements with an aerodynamic force platform that we had available for the same species flying over a similar distance. Whereas the lift predictions of the Kutta-Joukowski theorem and the vortex ring model stayed relatively constant despite vortex breakdown, their values were too low. In contrast, the actuator disk model predicted lift reasonably accurately before vortex breakdown, but predicted almost no lift during and after vortex breakdown. Some of these limitations might be better understood, and partially reconciled, if future animal flight studies report lift calculations based on all three quasi-steady lift models instead. This would also enable much needed meta studies of animal flight to derive bioinspired design principles for quasi-steady lift generation with flapping wings.

Determination of Multiresidue Pesticides in Botanical Dietary Supplements Using Gas Chromatography-Triple-Quadrupole Mass Spectrometry (GC-MS/MS).

A simplified sample preparation method in combination with gas chromatography-triple-quadrupole mass spectrometry (GC-MS/MS) analysis was developed and validated for the simultaneous determination of 227 pesticides in green tea, ginseng, gingko leaves, saw palmetto, spearmint, and black pepper samples. The botanical samples were hydrated with water and extracted with acetonitrile, magnesium sulfate, and sodium chloride. The acetonitrile extract was cleaned up using solid phase extraction with carbon-coated alumina/primary-secondary amine with or without C18. Recovery studies using matrix blanks fortified with pesticides at concentrations of 10, 25, 100, and 500 µg/kg resulted in average recoveries of 70-99% and relative standard deviation of 5-13% for all tested botanicals except for black pepper, for which lower recoveries of fortified pesticides were observed. Matrix-matched standard calibration curves revealed good linearity (r(2) > 0.99) across a wide concentration range (1-1000 µg/L). Nine commercially available tea and 23 ginseng samples were analyzed using this method. Results revealed 36 pesticides were detected in the 9 tea samples at concentrations of 2-3500 µg/kg and 61 pesticides were detected in the 23 ginseng samples at concentrations of 1-12500 µg/kg.

Risk Factors and Best Practices for the Prevention of Post-Cardiac Surgery Surgical Site Infections in a Tertiary Care Centre.

BACKGROUND: Post-cardiac surgery surgical site infections (SSIs) pose devastating consequences in terms of morbidity and mortality to patients. OBJECTIVE: To examine current risk factors and best practice perioperative care for prevention of SSI following cardiac surgery through the lens of the demographic/clinical characteristics of patients who developed post-cardiac surgery SSIs at a major tertiary care institution, and to identify where documentation is lacking and could be improved to better serve clinical practice. METHODS: A literature review on post-cardiac surgery SSI prevention and risk factors was performed. These risk factors were examined through a retrospective chart review of the population of patients who developed SSIs during the study period. RESULTS: The study population was characterized by a high prevalence of riskfactors including age, diabetes, obesity, operative time, blood glucose control, surgical re-exploration, blood transfusions, and emergency context, as well as differences from best practice guidelines such as preoperative showering. Compared to other populations in the literature, several ofthese risk factors were more prevalent at the study site than in the other comparable populations. CONCLUSION: The patient population had a relatively high prevalence of riskfactors, and the care received by these patients varied in some ways from best practices. Using best practice guidelines, known risk factors, and the data specific to the institution can provide insightsfor analysis and practice improvement efforts in the form of identifying at-risk patients, improving adherence to best practice guidelines, targeting areas to focus care efforts, and improving clincal documentation.