Journal articles on the topic 'Circle with pockets'

The flow in a hydrostatic pocket is numerically simulated using a dimensionless formulation of the 2-D Navier-Stokes equations written in primitive variables, for a body fitted coordinates system, and applied through a collocated grid. In essence, we continue the work of Braun et al. 1993a, 1993b] and extend it to the study of the effects of the pocket geometric format on the flow pattern and pressure distribution. The model includes the coupling between the pocket flow and a finite length feedline flow, on one hand, and the pocket and its adjacent lands on the other hand. In this context we shall present, on a comparative basis, the flow and the pressure patterns at the runner surface for square, ramped-Rayleigh step, and arc of circle pockets. Geometrically all pockets have the same footprint, same lands length, and same capillary feedline. The numerical simulation uses the Reynolds number based on the lid(runner) velocity and the inlet jet strengthFas the dynamic similarity parameters. The study aims at establishing criteria for the optimization of the pocket geometry in the larger context of the performance of a hydrostatic bearing.

Tests were carried out using a pin-on-disc tester under starved lubrication conditions. To achieve a conformal contact, a special construction was used with an adjustable counter sample. Textured surfaces with two dimple patterns (spiral an radial) and four shapes (circle, oval, triangle, and chevron) were tested. The contact area was lubricated with L-AN-46 oil. Before the tests, surface topographies of the discs were measured by a white light interferometer Talysurf CCI Lite. Tests showed that, in starved lubrication conditions, oil pocket shape and pattern affected the friction force.

The paper presents a new rotor design of an external coupling Lobe pump driven by pair of elliptical gears. The new rotor is a four-tooth elliptical gear with tooth profile is a improve cylocid curve. The improve cylocid curve is the locus of the fixed point on the generation circle, when the circle a pure rolling without slipping on the elliptical centrode of the rotor. The conditions of the rotor addendum and dedendum profiles are also considered. The limited supply angle addendum and dedendum rotor profiles are determined through an iterative algorithm when the generation circle makes a pure rolling without slipping on the ellipse base of the rotor. From there, we proceed to determine the pump design parameters according to the characteristic design parameters forming the rotor profile. The flow rate of the pump is determined by the area of the pockets on a cross-section perpendicular to the pump shaft. On that basis, a Matlab program is written from the mathematical model established by the paper to calculate the rotor design. In addition, the paper also investigates the effect of the coefficient l (semi-major axis divided semi-minor axis of the elliptical centrode ) on the average flow and axis distance. Survey results show that the design at l = 0.5 flow is 52.17% larger and the axis distance is reduced by 21.43% when compared to the traditional design at l = 1. This is the advantage of the new design proposed by this study.

Baromura hill of Tripura is characterised by complex geology and very rugged landform. Water scarcity is a very general problem for the remote hilly villages of this area. Thus groundwater is considered as one of the most valuable natural resources in hilly villages of Baromura hill. The present study aims to prepare small area survey based geo-electrical mapping for understanding groundwater condition in some selected pockets of the study area. For that purpose one hill slope and one trough shaped low land (locally known as lunga) was selected. Soil resistivity meter was used for electrical survey. A circle plot was prepared for geo-electrical survey on the basis of which geo-electrical maps were drawn. In the studied hill slope morphology four sectors of ground water conditions were observed according to their electrical resistivity character namely shallowest zone, medium zone, deep zone and very deep zone. The trough shaped low land (lunga) is characterised by comparatively shallower condition of groundwater and it was divided into five classes namely near surface water, very shallow zone, shallow zone, medium shallow zone and medium zone. Though the depth of the water bearing strata cannot be detected by this method it is very suitable for understanding the groundwater potential zones in remote places like present study area.

Across the globe, incidence of oral afflictions like gingivitis and periodontitis are increasing at a very fast pace. Evidencearethere to support the fact that despite of being an oro-dental infection, periodontitis is associated with the systemic diseases too. Different ecological niches of oral cavity can harbor both pathogenic and non-pathogenic micro-organisms. Although the main cause of the disease is the anaerobic or the facultative anaerobic bacteria, other factors such as poor personal hygiene, diet and immune related disorders are also responsible for the progression of the disease. The vicious circle starts from deposition of the bacterial plaque/biofilm on the tooth surface then leading to gingivitis. If left untreated, it progresses to the development of periodontal pockets and ultimately tooth loss. However traditional treatment modalities like high dose of systemic antibiotics are available but antimicrobial resistance and virulence of the periodontal pathogens is the major cause of the treatment failures. This review primarily focuses on the etiology, pathogenesis and microbiology of the periodontitis. It also discusses the virulence and antimicrobial resistance factors of the periodontopathic micro-organisms. It is an attempt to develop the thorough understanding of the disease so that better therapeutic outcomes of periodonto-therapy can be attained.

Urban poverty alleviation is the major thrust of development planning in India. However, poverty eradication is a daunting task as the problem is gradually increasing due to migration of rural poor people in urban centres. Urban poverty is a major challenge before the urban managers and administrators of the present time. Though the anti-poverty strategy comprising of a wide range of poverty alleviation and employment generating programmes has been implemented but results show that the situation is grim. Importantly, poverty in urban India gets exacerbated by substantial rate of population growth, high rate of migration from the rural areas and mushrooming of slum pockets. Migration alone accounts for about 40 per cent of the growth in urban population, converting the rural poverty into urban one. Moreover, poverty has become synonymous with slums. The relationship is bilateral i.e. slums also breed poverty. This vicious circle never ends. Most of the world’s poor reside in India and majority of the poor live in rural areas and about one-fourth urban population in India lives below poverty line. If we count those who are deprived of safe drinking water, adequate clothing, or shelter, the number is considerably higher. Moreover, the vulnerable groups such as Scheduled Castes, Scheduled Tribes, minorities, pavement dwellers etc., are living in acute poverty. Housing conditions in large cities and towns are depicting sub human lives of slum dwellers. With the reconstruction of poverty alleviation programmes in urban India, it is expected that social and economic benefits will percolate to the population below the poverty line. However, eradication of poverty and improving the quality of life of the poor remain one of the daunting tasks. Government of India has introduced numerous centrally sponsored schemes from time to time. Rajiv Awas Yojana, Rajiv Rin Yojana and National Urban Livelihood Mission are the new addition for poverty alleviation in urban area.

It can be emphasized that depending on the types of human activities, whether is that common, simple or high, the types of lexical language units function, moving from one conceptual level to the other according to the need of the communication necessities presented in front of the language. It can be noticed clearly, not rarely, in technical communication, as in other communications, and particularly in this case, the same sign as a lexical unit that expresses a common concept of wide content can also indicate a concept of a special content , restricted to its use and known by a narrow circle of users of the language, as it can be said for foot (man) and foot (mineral), pocket (coat) and pocket (petroleum), horn (animal) and horn (anvil). In this case, with the highest level in which the word rises, a modified concept of a lower or higher degree is also associated comparing with the meaning of the unit it’s coming from, for example, pocket (higher), compared to pocket (coat) (lower). In another case, raising the word to a higher level can only be considered as a transition to another level, but more or less of the same conceptual content. This type of concept, which is also called a dual concept (Duro, 1983: 113), makes the same unit to elevate to the highest level, in addition to the concept that expresses as: door1 (common word) and door1.1 . (building), window1 (house) and window1.1. (buildings), as a special common unit and of construction field.

A formal village/neighbourhood planning process is typically focused on three planning levels (national, regional and local) and is usually linked with administrative units of the territory (state, region or municipality). The local planning level (village or neighbourhood) “pocket plan” is a development challenge for spatial planners. The small coastal village Tuja in Latvia was taken as a pilot territory for “pocket planning” due to the unique location; biodiversity and ecosystems; significant natural, cultural, economic and social values; specific interests; and the needs of the involved local society. All these factors create a dynamic flow of data and information. Geographic information systems (GIS) are widely used as planning support systems. GISs for pocket plans must accommodate the special needs of communities in villages and neighbourhoods. Ensuring the availability of information in dynamic real time is an opportunity to build both community integration in specific environments and to understand the future plans of the territory. Access to a WEB-GIS (internet GIS) provides possibilities for every person with a mobile phone to use and update information. Static and statistical information is generally used for spatial planning. For pocket plans, the data and information flow has to be dynamic and has to interact with non-professional users. The special wishes and needs of every member of a community must be accommodated by a pocket plan for the well-being of the people and the sustainability of the surrounding territory. Small territory planning involves a very narrow circle of individuals or communities that identify spatial development needs for the future, which includes the socio-economic, cultural, historical, environmental and climate change scenarios. In order to assess the development opportunities and needs of such areas, the detection, accumulation and monitoring of reliable data is necessary. Methodically derived data (facts) provide objectivity and transparency. Currently, as information between the present and the past is able to circulate very fast, analysis of the current situation to forecast the future and show different constructed realities (scenarios) using a GIS is necessary. Therefore, to explore and determine a local needs-based and smart spatial planning approach, we must identify indicators that can be used for the short-term and long-term analysis of specific territories in coastal areas.

ABSTRACT Purpose To analyze the corneal thickness development after MyoRing implantation as a tissue-related indicator of keratoconus progression. Materials and methods Twelve eyes suffering from keratoconus were treated for visual rehabilitation by means of MyoRing implantation into a corneal pocket. The postoperative development of the corneal thickness at the thinnest point was analyzed. Follow-up ranged from 16 to 74 months (mean 37 months). Results Out of the 12 eyes only one eye showed a thinner cornea at the last follow-up 60 months after MyoRing implan-tation compared to the last preoperative data. None of these 12 eyes required an additional intervention like corneal cross-linking, explantation or keratoplasty. Four eyes showed even thickening of the cornea during the postoperative period. Conclusion MyoRing implantation for keratoconus does not only allow visual rehabilitation. It also seems to stop the progression of the disease by creating a new biomechanical equilibrium within the tissue which eliminates a constant stimulus that drives the vicious circle of progression. How to cite this article Daxer A. Corneal Thickness after MyoRing Implantation for Keratoconus. Int J Kerat Ect Cor Dis 2014;3(1):15-19.

The family Enchelidiidae is recovered as monophyletic and appears to be a more recently derived taxon within the superfamily Oncholaimoidea. It combines nematodes with buccal cavity with three unequal teeth, crenate pharynx, and absence of demanian system. Genus Thoonchus was erected for nematodes characterized by the large buccal cavity with heavily cuticularized walls and several rows of denticles, short and arcuate spicules and gubernaculums with expanded corpus. One new species is described here from the Sishili Bay, located in the northern Yellow Sea. Thoonchus covidus sp. nov. is characterized by the body length 3195‒4339 µm, outer labial and cephalic setae in one circle, pocket shaped amphid above the buccal cavity base, secretory-excretory pore at the base of cephalic setae, arched spicules, gubernaculum with thin proximal extension parallel to spicules, preanal supplement absent, three pairs of preanal papillae. It differs from other congeners by the position of secretory-excretory pore, absence of supplementary organ in males and presence of three pairs of precloacal papillae. Redescription of T. giganticus is also provided. After critical evaluation of the genus we recognize 4 valid species and provide a taxonomic key to species.

P34 Epidemiological studies have demonstrated a significant association between periodontal disease and increased risk of cardiovascular disease. Periodontal organisms were hypothesized to be the underlying factor for the association. This study investigated the relation of myocardial infarction (MI) with both periodontal health status and presence of periodontal pathogens in subgingival plaque. The study sample included 171 MI cases and 574 controls who had at least 6 teeth and were residents of Erie and Niagara counties of New York. Periodontal assessments included pocket depth and attachment loss. Subgingival plaque was sampled and tested using immunofluorescence microscopic technique for the presence of Bacteriodes forsythus (BF), Porphyromouas gingivilis (PG), Prevotella intermedia (PI), and Campyglobacter recta (CR). Results: Mean (SD) pocket depth (mm) was 2.2 (0.7) for MI cases and 2.0 (0.5) for controls (p<0.01). Mean (SD) attachment loss (mm) was 2.6 (1.2) and 2.2 (0.7) for cases and controls (p<0.01), respectively. Presence of periodontal pathogens was significantly more frequent among MI cases than controls. For the four bacteria (BF, PG, PI, and CR), the prevalence (%) of subgingival bacterum presence was 45.0, 14.6, 39.8, and 12.3 among MI cases, and 26.8, 8.2, 31.2, and 5.1 among controls. After adjustment for sex, age, education, smoking status, alcohol use, body mass index, diabetes status, and dental plaque index using logistic regression, the odds ratios (95% confidence intervals) of MI were 1.62 (1.17-2.25) for pocket depth (per 1 mm change), 1.36 (1.10-1.69) for attachment loss (per 1 mm change), 1.93 (1.30-2.88) for BF, 1.41 (0.81-2.48) for PG, 1.18 (0.80-1.73) for PI, and 1.83 (0.96-3.52) for CR presence in subgingival plaque. In conclusion, this case-control study demonstrated that poorer periodontal status and presence of specific bacteria such as BF in subgingival plaque were associated with an increased risk of MI.

Nearly a decade into the new millennium, the teaching of political literacy as a strand of education for citizenship has taken on a new urgency throughout much of the world. In most developed countries there is now a feeling that young people need to develop a healthy respect for democratic procedures and consequent methods of participating to shape modern society and an understanding that real political literacy means moving beyond the strictures of traditional civics courses. The introduction into places as far apart as Scotland and Hong Kong of aspects of political education in primary schools (Cheung & Leung 1998; Maitles 2005) has itself reflected a worry (almost a moral panic) in government circles about youth alienation, albeit with some debate as to whether schools should be the places where this is developed. This paper examines the attitudes of young people towards politics, explains some peculiarities of education in Scotland and reports on research into the knowledge, interest, cynicism/trust and values/attitudes of approximately 1600 pupils – 50% of whom study Modern Studies whilst the others study history or geography. The paper explores whether those pupils studying Modern Studies have a stronger basis in some elements of political literacy than those who do not study it. The results suggest that Modern Studies students have more knowledge, greater interest and are less cynical but, that in terms of values, there is no discernible difference.

Prof. Radovan Danic, PhD (1893-1979), an honorary lifetime President of the Astronomical Society Rudjer Boskovic in Belgrade, owned a brass universal equinoctial ring sundial (98 mm in diameter), preserved by his descendants, who continued his work on popularizing astronomy through the activities of the society. The sundial (ring dial) was measured, tested and compared to similar portable sundials (pocket sundials) exhibited in various European museums. In the classification scheme, along with the Parmenion?s and astronomical rings, it belongs to a group of pocket armillary sundials that do not require a compass. More precisely, it is a self-orienting armillary sundial whose rings are located under the circles of the celestial sphere of the same name at the moment of measurement. Therefore, when the apparent solar time is known, it turns into a solar compass. A corresponding sundial on the horizon to the self-orienting armillary sundial is the analemmatic sundial. The construction of a self-orienting armillary sundial was first described in the late 16th century by the English mathematician William Oughtred (1574-1660). In collaboration with the gnomonists from England and Austria, we determined where and when Professor Danic?s sundial was constructed: Vienna, second quarter of the 18th century. Originally, the sundial was adjusted for the latitude of Belgrade or Zemun (nowadays, a Belgrade municipality), which were under the Austrian rule for a long time during the 18th century. It is a beautiful, well-crafted, well-preserved, expensive sundial and astronomical instrument that should be kept in a museum, in the first place in the Museum of Astronomy of the Astronomical Observatory in Belgrade.

ABSTRACTThe identification of novel antiretroviral agents is required to provide alternative treatment options for HIV-1-infected patients. The screening of a phenotypic cell-based viral replication assay led to the identification of a novel class of 4,5-dihydro-1H-pyrrolo[3,4-c]pyrazol-6-one (pyrrolopyrazolone) HIV-1 inhibitors, exemplified by two compounds: BI-1 and BI-2. These compounds inhibited early postentry stages of viral replication at a step(s) following reverse transcription but prior to 2 long terminal repeat (2-LTR) circle formation, suggesting that they may block nuclear targeting of the preintegration complex. Selection of viruses resistant to BI-2 revealed that substitutions at residues A105 and T107 within the capsid (CA) amino-terminal domain (CANTD) conferred high-level resistance to both compounds, implicating CA as the antiviral target. Direct binding of BI-1 and/or BI-2 to CANTDwas demonstrated using isothermal titration calorimetry and nuclear magnetic resonance (NMR) chemical shift titration analyses. A high-resolution crystal structure of the BI-1:CANTDcomplex revealed that the inhibitor bound within a recently identified inhibitor binding pocket (CANTDsite 2) between CA helices 4, 5, and 7, on the surface of the CANTD, that also corresponds to the binding site for the host factor CPSF-6. The functional consequences of BI-1 and BI-2 binding differ from previously characterized inhibitors that bind the same site since the BI compounds did not inhibit reverse transcription but stabilized preassembled CA complexes. Hence, this new class of antiviral compounds binds CA and may inhibit viral replication by stabilizing the viral capsid.

Abstract Background ABL001 (Novartis) is an allosteric inhibitor that binds to the myristate binding pocket of Abl to hold Bcr-Abl in the inactive conformation. A Phase I multicentre trial of ABL001 in chronic myeloid leukemia (CML) is ongoing (Protocol CABL001X2101), and includes testing ABL001 in combination with the ATP-competitive Tyrosine Kinase Inhibitors (TKIs) imatinib (IM), nilotinib (NIL) and dasatinib (DAS) to determine if simultaneous targeting of the myristate and ATP binding pockets provides greater pharmacological inhibition of Bcr-Abl and promotes greater reduction in tumor burden. In vitro sensitivity to TKIs can be measured by assessing the phosphorylation status of the Bcr-Abl substrate CrkL. Using this method, high IM in vitro sensitivity at diagnosis (IC50IM <0.6 µM; White et al, Blood 2005) is predictive of molecular response for patients treated with 600 mg IM. Aim To investigate if the in vitro combination of ABL001 (at a pharmacologically-relevant concentration) with ATP-competitive inhibitors is more effective atBcr-Abl kinase blockade than IM, NIL or DAS as single agents. Methods Blood mononuclear cells (MNC) were isolated with informed consent either prior to TKI therapy (n=6 de novo chronic phase CML patients) or at TKI-switch (n=4 resistant, intolerant or non-compliant patients). For in vitro sensitivity, MNC were treated for 2 h with a pre-determined range of concentrations of IM, NIL and DAS -/+ 1.2 µM ABL001 (based on human PK parameters from Novartis, average peak plasma concentration on 40 mg BID = 578 ng/mL or 1.24 µM) or a much lower dose of 1.2 nM; or with ABL001 alone. Phosphorylated-Crkl (p-Crkl) levels were determined by western blot and the IC50 was calculated by densitometry. Results Kinase inhibition was markedly enhanced by addition of 1.2 µM ABL001 as compared to TKIs alone with mean IC50s without and with ABL001 of 1.52 µM ± 0.46 µM vs. 0.019 µM ± 0.012 µM (p=0.014), 79.1 nM ± 8.8 nM vs. 0.26 nM ± 0.22 nM (p<0.0001) and 2.3 nM ± 0.3 nM vs. 0.014 nM ± 0.007 nM (p=0.002) for IM, NIL and DAS respectively (Fig 1A-C). Since NIL and DAS IC50 values were reduced to picomolar levels in the presence of 1.2 µM ABL001 we then tested a 1000-fold lower ABL001 concentration of 1.2 nM. Similar results were obtained: the observed reductions in IC50s with 1.2 nM ABL001 were 86% (n=8, p=0.013), 72% (n=9, p<0.0001) and 90% (n=3, p=0.0024) for IM, NIL and DAS respectively (Fig 1A-D). In contrast, ABL001 alone was unable to completely inhibit phosphorylation of Crkl in 2 h, thus IC50 calculation was not possible. Collectively, 8 patients of various disease status were tested with IM and all had high IC50IM >0.6 µM, however, with the addition of just 1.2 nM ABL001, the IC50IM was reduced in all cases to <0.6 µM (Fig 1D, p=0.0078), a level that predicts excellent outcomes with IM therapy. The ABL001-induced reductions in TKI IC50s were of similar magnitudes in previously untreated patients as well as those switching TKIs for resistance or intolerance. Conclusions These data suggest that (1) in vitro kinase inhibition achieved with ABL001 in combination with IM, NIL or DAS is greater than that achieved with TKIs alone, even at a concentration 1000-fold lower than achievable on the current ABL001 dosing regimen; and (2) patients with high IC50IM who would be predicted to respond poorly to 600 mg IM have dramatically increased kinase inhibition with the addition of just 1.2nM ABL001. These results suggest that simultaneous targeting of themyristate and ATP binding pockets ofBcr-Abl may be more effective than targeting either site alone and provides a strong rationale for combining IM and ABL001, particularly in patients with low intrinsic sensitivity to IM. Figure 1 Addition of 1.2 nM or 1.2 µM ABL001 to ATP-competitive TKIs increases the degree of Bcr-Abl kinase inhibition achieved in vitro in CML mononuclear cells.Patient MNC were incubated for 2 h with (A) IM (B) NIL and (C) DAS + 1.2 nM (middle) or 1.2 µM (right) ABL001 and IC50 calculated by determining the concentration of TKI causing 50% reduction in p-CrkL. Solid dots represent diagnosis patients; open circles represent patients switching TKI for intolerance or resistance; Numbers are shown in parentheses; Black lines are means; error bars are SEM. The eight patients in (A) are shown in (D) paired with their response to 1.2 nM ABL001 (dotted line indicates the average IC50IM for 62 de novo CMLs in the TIDEL trial). Figure 1. Addition of 1.2 nM or 1.2 µM ABL001 to ATP-competitive TKIs increases the degree of Bcr-Abl kinase inhibition achieved in vitro in CML mononuclear cells.Patient MNC were incubated for 2 h with (A) IM (B) NIL and (C) DAS + 1.2 nM (middle) or 1.2 µM (right) ABL001 and IC50 calculated by determining the concentration of TKI causing 50% reduction in p-CrkL. Solid dots represent diagnosis patients; open circles represent patients switching TKI for intolerance or resistance; Numbers are shown in parentheses; Black lines are means; error bars are SEM. The eight patients in (A) are shown in (D) paired with their response to 1.2 nM ABL001 (dotted line indicates the average IC50IM for 62 de novo CMLs in the TIDEL trial). Disclosures Yeung: Novartis Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Ariad: Research Funding. White:Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Ariad: Consultancy, Honoraria, Research Funding; Novartis Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Hughes:Australasian Leukaemia and Lymphoma Group (ALLG): Other: Chair of the CML/MPN Disease Group; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

P33 Epidemiological studies have demonstrated a significant link between periodontal disease (PD) and increased risk of cardiovascular disease (CVD). This study was conducted to evaluate if lipid metabolism and peroxidation may represent potential pathways linking PD to CVD. The study sample included 747 randomly selected residents of Erie and Niagara counties of New York who had 6 or more teeth and no history of heart attack. Periodontal assessments included pocket depth (POD) and attachment loss (ATL). Periodontitis was defined by 2+ teeth with ATL≥6mm and 1+ teeth with POD≥5mm. Subgingival plaque was sampled and tested using immunofluorescence microscopic technique for the presence of four putative periodontal pathogens: Bacteriodes forsythus (BF), Porphyromouas gingivilis (PG), Prevotella intermedia (PI), and Campyglobacter recta (CR). Fasting blood sample was obtained and determinations of total and LDL cholesterol, triglycerides, and plasma thiobarbituric acid reacting substance (TBARS) were performed. In the sample as a whole, prevalence of specific bacteria in the subgingival plaque were 29.6% for BF, 8.3% for PG, 31.6% for PI, and 4.4% for CR. As expected, prevalence was much higher in participants with periodontitis. Presence of BF and CR (but not PI and PG) was associated significantly with higher levels of LDL cholesterol (Mean LDL cholesterol (mg/dl), 151.3 for BF + and 142.8 for BF -, p<0.05; and 158.4 for CR + and 144.7 for CR -, p<0.05). Presence of PG and CR (but not BF and PI) was significantly associated with higher TBARS (Mean TBARS (nmol/ml), 1.51 for PG + and 1.38 for PG -, p<0.05; and 1.57 for CR + and 1.38 for CR -, p<0.05). These associations remained statistically significant after adjustment by sex, age, education, body mass index, diabetes status, smoking and alcohol use. No significant association with bacteria was found for total cholesterol and triglycerides. In conclusion, subgingival presence of specific periodontal bacteria (bf, pg, and cr) was associated with higher serum LDL cholesterol and/or plasma TBARS. This suggests that lipid alteration and peroxidation may represent potential pathways in the link between PD and CVD.

Citrus groves of Corfu had been attacked during the last decade by citrus whitefly Dialeurodes citri (Ashmead). It presumably expanded later, and it was found to cause a serious infestation on lemon trees of Achaia region during summer of 1986, while it disappeared later existing today only in very small pockets on ornamental citrus species in Attica area. Late in August 1988, the leaves of citrus trees, and to a lesser extent of grapevines, in the region of Corinthia, NE Peloponnesos, in South Greece were covered by larvae, pupae and adults of a whitefly that was different from D. citri. In autumn of the same year, it was noticed that the infestation of this new whitefly had expanded to other parts of Peloponnese such as Argos, Patras and Ilia region. Samples of citrus and grapevine leaves with nymphs of the insect were sent for identification to British Museum of Natural History. Dr. J. H. Martin identified the species as Parabemisia myricae (Kuwana) (Homoptera: Aleyrodidae), making the first record of the species in Greece. The species is a native of Japan and possibly of other eastern asian countries such as Taiwan and West Malaysia. Today, the insect has been recorded in USA (California), Cyprus, Israel and Turkey, Egypt (Martin personal communication) and it is a pest of woody plants, especially citrus trees and grapevines. The damage caused to the plants by this insect, as a feeder, can be serious in cases of large populations accompanied with problems associated with the development of sooty mould on the excreted honeydew. In the autumn of 1988, infestation was high (more than 20 nymphs/leaf) in Achaia and Corinthia regions of N. Peloponnese, causing great concern to citrus growers. This species of whitefly was not included in the lists of known plant pests of Greece. It is probable that it invaded Greece from Israel. P. myricae is a newly introduced pest in citrus growing countries and there is little information available on its biology and control. Most of the published data comes from Israel and California on the biology and biological control of the insect. Additional data have been published on flight behaviour, oviposition behaviour, and survival of young nymphs on leaves of different age citrus leaves. The adults of P. myricae are smaller than D. citri adults and they have a dusty blue gray or lavender appearance. The females oviposit on very young leaves, often in circles. Preference for oviposition on very young leaves seems to be related to properties of the leaf cuticle. Leaf age is a critical factor for survival of nymphs. This gives a good explanation for the observed high rates of mortality in spring for nymphs growing on rapidly maturing leaves. It has been observed that on orange trees less eggs are layed on the lower surface of the leaves, while on lemon trees they tend to be layed equally on both surfaces. Initially eggs are off-white, while after about one day they gradually turn to brownish and finally black, before they hatch. First instar crawlers settle on the surface of the young leaves with a preference to the lower surface. First flights of adults were noticed in this area in late February of 1989. By end of March early April the emergence of adults of the first 1989 generation had been completed. It seems that it produces a quite large number of generations during the year, as it requires only 21 days at temperatures fluctuating between 210oC and 17.3oC and 65-100 percent relative humidity, to complete its cycle in glasshouse. Being a pest of Citrus and grapevines (Vitis vinifera) it has also been found on hosts like Ficus, Persea, Prunus, Psidium and Thea. As a matter of fact it has also been found in small colonies on Prunus cerasi in Northern Peloponnese in autumn 1988. Work on the control of Parabemisia myricae with the insect growth regulator Buprofezin has started in Greece in 1988 and is expected to be concluded in 1990.

Abstract Plunge milling has been proven to be an efficient strategy for machining of pockets with deep cavities and difficult-to-cut material. Previous work generates the plunge toolpath mainly by controlling the radial cutting width within the given value. However, uneven tool engagement angles may lead to excessive tool load and tool load fluctuations, which has a negative influence on tool life. In this study, a universal plunge milling toolpath generation method is proposed to improve tool life by decreasing the maximum tool engagement angle. A series of concentric circles with constant radius increment is utilized to generate a toolpath with constant cutting radial depth. Center of the concentric circle is determined based on the pocket contour. New detailed algorithms to generate plunge toolpath for basic cases have been developed. An automatic pocket subdivision algorithm has been developed by dividing the pocket into several subregions that are easy to be machined. Without loss of generality, the method is applicable for both open and closed pockets. It also works for pockets with and without islands inside. The method is implemented and verified successfully by machining experiments. The results provide strong evidence that the proposed method can reduce the maximum engagement angle over the entire toolpath and thus improve the tool life.

High-speed machine tools typically provide high spindle speeds and feedrates to achieve an effective material removal rate (MRR). However, it is not possible to realize the full extent of their high-speed capabilities due to the sharp corners of toolpaths which are introduced by conventional machining strategies, such as contour- and direction-parallel toolpaths. To address this limitation, spiral toolpaths that can reduce the magnitude of sudden direction changes have been developed in previous researches. Nevertheless, for some pockets, the average radial cutting width is significantly decreased while the total length of the toolpath is significantly increased as compared to contour- and direction-parallel toolpath. In this situation, spiral toolpath may take more machining time. To overcome these drawbacks, an aggressive spiral toolpath generation method based on the medial axis (MA) transformation is proposed in machining pocket without islands inside, which refers to no additional material inside the counter. The salient feature of this work is that it integrates the advantages of both conventional contour-parallel machining strategy and the existing spiral toolpath machining strategy. The cutting width at each MA point is determined based on the diameter of the locally inscribed circle (LIC) of the MA point and the topological structure of MA. A distance-constrained contour determination algorithm is utilized to calculate the toolpath for each pass. Finally, a circular arc transition strategy is used to transform all the isolated passes into a spiral toolpath. Experiments are conducted to show the effectiveness of the proposed method.

Plunge milling is an effective roughing operation, especially in pockets roughing, because it can efficiently remove a large amount of stock material without high manufacturing costs. However, plunge milling of complex pockets with islands, whose boundaries could be designed with free-form curves, is quite challenging for multiple plungers have to be used including small plungers to cut necks between islands and their plungers paths are expected to have fewer times of plunging and shorter travel to achieve efficient machining. Unfortunately, little research on this topic was carried out in the past, and the challenge has not been addressed yet. In this research, a new approach is proposed to generate plunger paths for efficient plunge milling of the complex pockets. Its main features include (1) packing plunger circles at a minimum number of locations inside the pocket for fewer times of plunging, (2) placing plunger circles to cover the areas enclosed by the afore-packed circles to clear out the interior pocket material, and (3) planning the shortest paths to connect plunger locations for less traveling time. The advantages of this new approach over the overlapped circles filling (OCfill) and the Catia methods are demonstrated with two examples, and it can be directly used for pocket plunge milling in industry.

Abstract Background Oral health, such as other health conditions, reflects social inequalities. These inequalities are fed back by oral diseases, generating a vicious and sustainable circle. Racial issues play a prominent role, once they are associated with oral diseases as risk markers. Among the different oral diseases, periodontal disease associated with racial inequalities in adolescents is emblematic. Thus, this study aimed to analyse the race differentials associated with the levels of periodontal disease, regardless of other risk factors. Methods Data from the 2010 national epidemiological survey on oral health were used, with 5445 adolescents (15 to 19 years old). Multinomial logistic regression models were used. Dependent variable was the Community Periodontal Index. Independent variable was self-declared race/colour, categorized as white, pardo (mixed-race identity) and preto (black). The effect of race was controlled in the presence of the covariates sex, years of study, decayed, missing and filled permanent teeth (DMFT index), toothache and self-reported need for dental treatment. Odds Ratio (OR) was estimated and sample weights were considered. Results The simple model showed preto with 2.7 (p &lt; 0.05) and 8 (p &lt; 0.05) times more likely to have shallow and deep periodontal pockets, respectively, compared to white. Pardo was 1.5 (p &lt; 0.05) times more likely to have periodontal calculus. In the multiple model, even in the presence of all independent covariates, preto showed association with shallow pockets (OR = 2.51, p &lt; 0.05) and pardo showed association with the presence of calculus (OR = 1.37, p &lt; 0.05). Conclusions Regardless of sex, education, perception of pain and need for treatment and the DMFT index, race/colour was associated with periodontal problems. It should be noted that skin colour is not a biological risk factor for periodontal disease. However, the findings of this study revealed racial inequities regardless of socioeconomic variables. Key messages Raises the need to guarantee health as a resource for social development, with science having a fundamental role in recovering the citizenship of this historically forgotten population. The findings of this study revealed racial inequities regardless of socioeconomic variables.

Winters, Kari-Lynn and Lori Sherritt-Fleming. Hungry For Math: Poems to Munch On, illustrated by Peggy Collins. Fitzhenry & Whiteside, 2015.Winters and Sherritt-Fleming seemingly intend this picture book to introduce those mathematical skills and concepts that children learn in their first years of schooling: shape recognition, counting, telling time, and using money. The authors append a glossary that defines such terms as “Base Ten,” “Ordinal numbers,” and “Rhombus.” Having raised our expectations that this will be a mathematically informative book, they get off to a bad start in a rhyme entitled “The Balanced Bee.” “Three circles, tall not wide,”Now, surely, if we are going to define a rhombus for the picture book crowd, we can also allow that a circle is a closed curve with all points on that curve equidistant from the centre. (In other words, it cannot be “tall not wide.”) Their presentation of the concept of time uses a variation on an old standby: “Hickory, Dickory Dock” in “Move Around the Clock.” At one time, the original rhyme was relevant to children because it referenced the nature of a clock. Sometimes, that clock had a pendulum or a sweep second hand to mark the passing seconds; always, it had hands that pointed to the minutes and the hours. Not all clocks chimed, but one could at least see the hands “strike” the hours. Most importantly, the numbers one to twelve circled the clock face and, thus, provided a visual clue to their sequence. Children learned of this sequence without being particularly aware of their learning.For today’s young child the typical “clock” is a digital strip on a microwave, or a smart phone, or an adult’s wrist strap. The numbers on it change either second by second or minute by minute. Staring at this strip which might, for example, read “1:30 p.m.”, how does a child know that “1:00 p.m.” arrived a half hour earlier, that “2:00 p.m.” will arrive a half hour hence, and that “12:30 a.m.” will arrive in a further eleven hours? The concept is no longer visually obvious. This book does not illuminate it. Despite a text which reads, “The mouse ran up the clock,” the mouse in Peggy Collins’ illustration does not run “up” anything: it hops along insouciantly through the gears and springs and winding key of a technology now unknown to children. Nor does the mouse progress systematically through the hours. The text accompanying its romp reads, “…three o’clock, four-thirty, seven o’clock…nine-thirty” …etc. Primary school teacherswould have to struggle to relate anything in this story sequence to the daily rotation of the earth, and humankind’s decision to mark its course in hours, minutes and seconds. Equally unhelpful is the rhymed story of the Spendosaur who wastes all his pennies at the candy store. The penny was discontinued in Canada two years before the publication of this book. The coin’s time honoured usefulness as a counting device or an introduction to base ten is kaput. Increasingly, we use credit cards at the shops. We buy online using computers and hand-held devices. We need not count change; we can simply enter a figure representing the cost of our purchase on a digital screen. In sum, Canadian children of primary school age scarcely remember that their parents once carried pennies in their pockets, let alone that they actually used the copper coins to make purchases. “One penny buys a chocolate-dipped pickle.” becomes merely a line of amusing nonsense.In part, uncertainty of intent may have led to this picture book’s various problems. It attempts to be both an entertaining fantasy and an engaging teaching tool. The blurring of purposes here has not quite succeeded. Reviewer: Leslie AitkenNot recommended: 1 star out of 4Leslie Aitken’s long career in librarianship included selection of books for school, public, special and academic libraries. She is a former Curriculum Librarian for the University of Alberta.

Current ICD-systems use a non rechargeable dry battery as energy source. Thus, the life span of these systems is limited by the capacity of their battery. Therefore, this project deals with the development of a device (rechargeable ICD - rICD) being recharged transcutaneously by a magnetic field. Method: A prototype of this rICD consisting of an 4 th generation ICD housing containing a lithium polymer rechargeable battery, a charging coil for receiving the transmitted energy, integrated circuits for charging controls and a new telemetry system. These devices were tested in a long-term animal study in 10 Merino sheep (age 2±0.5 years, weight 54±9 kg) over a period of 1 year. By means of the telemetry system, the rICD was controlled. State of charge, LiIon voltage, charging current and temperature of LiIon battery, electronics and rICD housing were monitored continuously. Under general anaesthesia (ITN), the prototypes were implanted on the lateral neck of the sheep. The implantation of the devices, positions of charging coils and telemetry antennas as well as the implantation depths were documented by means of x-ray. All animals underwent monthly follow-ups with full charge-discharge cycles. At last, the animals were euthanatized and the ICD pockets were excised and analyzed microscopically. Results: Implantations were successful in all animals. Mean implantation depth was 2.2±0.6 cm. Monthly follow-up measurements showed that neither the tissue exposed to the electromagnetic field nor the device itself nor the LiIon battery presented with significant heating. Mean charging current was 34±11 mA. Thus, efficient charging of the LiIon battery was possible. One animal presented with a pocket infection. Other tissue alterations of the ICD-pockets have not been observed. Conclusion: The transcutaneous wireless energy transfer for rechargeable ICDs has been shown to be reliable, stable and effective in a long-term animal study.

Introduction: Systemic infection can occur in patients with cardiac devices due to spread from pocket infection or a non-pocket source. Data comparing outcomes of systemic infection from pocket vs. non-pocket source are lacking Hypothesis: We hypothesized that systemic infection from non-pocket source is associated with worse outcomes compared with pocket source. Methods: We collected data for all patients with systemic infection, who underwent transvenous lead extraction (TLE) between April 2004 and June 2015. Patients were divided into 2 groups- systemic infection from pocket source and non-pocket source. Results: Out of total 700 TLE procedures for infectious indication, 407 patients (58.1%) had evidence of systemic infection. Out of these, 167 (41%) had systemic infection from pocket source and 240 (59%) had systemic infection from non-pocket sources. Patients with pocket source were older (69.7± 13.4 vs. 66.3± 13.5 years, p value 0.011), less likely to be on dialysis (8.4% vs. 23.8%), and more likely to have CRT system (39.5% vs. 23.8%). Pocket source group had higher incidence of coagulase negative staphylococcus infection (32.3% vs. 19.6%) and presence of abandoned leads (32.3% vs. 10.8%).Patients with non-pocket source were more likely to have endocarditis (81.7% vs. 55.1%). There was no difference in TLE procedure outcomes, complications during hospital stay, and 30-day mortality (10.3% vs. 13.7%, p value 0.330). However, 1-year mortality was significantly higher in patients with non-pocket source (41% vs. 28.1%, p value 0.019). Kaplan-Meier survival curves showed worse survival in non-pocket source group up to 6 years of follow up. Conclusions: In conclusion, there is no difference in procedural or short-term outcomes between patients with systemic infection from pocket vs. non-pocket source after TLE. However, patients with systemic infection from non-pocket source are more likely to have endocarditis and have worse long-term mortality.

Background : Patients who are anti-coagulated following pulse generator implantation have a 20% risk of hematoma development in the pre-pectoral pocket. In general, hematomas are correlated with patient discomfort & pain, lead to increased risk of infections, & may require surgical drainage leading to longer hospitalization. Objectives : This investigation was conducted to evaluate safety & effectiveness associated with use of D-Stat ® Flowable Hemostat following implantation of a pulse generator compared to standard of care. Safety endpoint evaluated the incidence of major study-related adverse events & effectiveness endpoint evaluated the incidence rate of clinically significant hematomas. Clinically relevant hematoma was defined as alteration in the standard of care. Methods : Two hundred sixty nine anticoagulated patients were enrolled at ten sites & followed through 8 weeks post-procedure. Patients undergoing implantation were randomized to either D-Stat Flowable Hemostat or standard of care. Results : No statistical differences were observed in the baseline demographics between treatment groups. The D-Stat Flowable group presented with 65.4% males compared to 71.4% in the control group. Mean age was 73.3 years in the D-Stat Flowable group vs 72.2 years in the control group. Pulse generator distribution between the study groups was 54.4% pacemakers & 45.5% ICDs in the D-Stat Flowable group vs 54.9% pacemakers & 45.1% ICDs in the control group. The safety of the D-Stat Flowable was successfully demonstrated as the incidence rate of major complications experienced in both groups (D-Stat Flowable: 21.3%; Control: 27.8%) was equivalent (p value 0.0008). The effectiveness of D-Stat Flowable was successfully demonstrated as the overall rate of clinically relevant hematomas experienced in the D-Stat Flowable group (11.8%) was significantly less than that of the control group (22.6%) (p-value 0.0231). Conclusions : The findings from this investigation demonstrate the use of D-Stat Flowable within the pre-pectoral pocket in anti-coagulated patient population undergoing placement of a pulse generator is safe and effective. Use of D-Stat Flowable resulted in a 48% reduction in the rate of clinically relevant hematomas in the target population.

Introduction: Pocket management after device removal is unclear in patients with cardiac implantable electronic devices (CIEDs) infection. Capsulectomy has been proposed to reduce the risk of reinfection, this procedure is time consuming and requires extensive tissue debridement with a potential higher risk of hematoma formation. Hypothesis: The use of chlorhexidine and saline pocket irrigation without capsulectomy is effective in the management of CIED related infection. Methods: Patients who underwent transvenous lead extraction without capsulectomy for CIED-related infection were included. After complete hardware removal, thorough scrubbing of the generator pocket with 20 cc of 2% chlorhexidine followed by irrigation with 1L of saline was undertaken. The pocket was dried using sterile drapes and the wound was closed with separate intradermal absorbable suture. Implantation of a new CIED device and antibiotic treatment were given according to treating physicians’ discretion. Patients were followed up for 6 weeks after the procedure, and then every 6 months. Results: Between July 1 st , 2013 and May 1 st , 2019, 34 patients (68.1±10.6 years; 13 female) were included. Median follow-up was 745.5 days (IQ range 444.5-1418 days). Lead or device extrusion (41%) was the most frequent indication for extraction. Additionally, 38% of patients had endocarditis. In 75% of cases, bacteria were isolated from blood, pocket or lead tip cultures. Gram positive bacteria were the most frequently found organisms (59% of cases). In total, 19 patients (56%) had a new device implanted after the procedure; mean follow-up for this group of patients was 1251.1±678.8 days. Average time between device extraction and implant of a new device was 26 days, with 11 patients (32%) having device implant in the following week after extraction, including three patients (9%) who underwent dual chamber pacemaker immediately after lead extraction. There were no immediate or 30-day complications associated with chlorhexidine use. During follow-up, no patients presented recurrent infection. Conclusions: The use of chlorhexidine and saline pocket irrigation without capsulectomy offered excellent results with no cases of reinfection and without taking the risk of hematoma formation.

Introduction: Out-of-pocket costs are a major barrier to medication adherence in low and middle income countries and an important target for policy-level interventions. The total economic burden for patients receiving secondary penicillin prophylaxis for Rheumatic Heart Disease (RHD) is uncertain. Methods: We prospectively collected self-reported out-of-pocket drug, transportation, and provider costs from patients in the AIIMS Pediatric RHD Registry. Monthly costs were estimated by adjusting visit costs for frequency of drug administration. Because adverse drug reactions are rare, we did not collect complication-related costs. Mean (±SD) costs are reported in 2013 Indian Rupee (INR) and International Dollars (INT$). Results: In our registry, 230 patients provided cost data over 313 visits. The mean age was 11.8 (±2.9) years, and 83 (36%) were girls. The majority of patients resided in rural areas (n=197, 86%), and were from the lower and upper lower socioeconomic strata (n=160, 70%) on the modified Kuppuswami scale. Nearly all patients hailed from outside Delhi (91%), reflecting the referral population of our tertiary hospital. The monthly out-of-pocket cost was INR 74.92 (±109.00) or INT$ 4.04 (±5.88), drug cost forming 36% of the total costs (INR 26.71 [±11.6]; INT$ 1.44 [± 0.63]). Provider costs (INR 18.21 [±32.48]) and transportation costs (INR 30.00 [±106.51]) comprised 24% and 40% of total costs respectively. Provider and transportation costs exceeded the drug costs for 38% of the patients. Patients traveled 12 (±38) km round trip to obtain penicillin prophylaxis. Conclusions: Drug costs constitute only 36% of the total out-of-pocket cost of penicillin prophylaxis for RHD, with provider costs (24%) and transportation costs (40%) comprising the remainder. Because out-of-pocket costs can be a major barrier to long-term adherence, future efforts must be directed at improving access to and lowering total costs of penicillin prophylaxis for RHD.

Anita McConnell, Instrument Makers to the World. A history of Cooke, Troughton, and Simms . University of York, William Sessions, York, 1992. Soft covers, 116 pp. £16.00. Eleanor Mennim, Transit Circle. The story of William Simms , 1793-1860. William Sessions, York, 1992. Soft covers. 302 pp. £9.50 It is unusual to find two books on such closely related subjects issued by the same publisher at virtually the same time. Yet both seem to have been funded independently of the publisher; Dr McConnell s excellent critical company history has been backed by Messrs Vickers of York, and Dr Mennim’s life of her ancestor, William Simms, by her own sponsors. One suspects, therefore, that William Sessions of York stand to be in pocket either way. In spite of their apparent similarity of theme and the fact that the eminent Victorian scientific instrument maker, William Simms, plays a starring role in both, they are none the less very different books. Anita M cConnell’s Instrument Makers to the World is clearly the work of a thorough-going professional scholar who traces the history of a scientific instrument- making firm through two and a half centuries down to its closure in 1988. Eleanor Mennim is a medical doctor who has produced a wandering and rather over-long biography of her great-great-grandfather without ever properly telling her readers what a Transit Circle actually is. Both books are quite independent creations with no collusion having taken place between the authors.

Importance: Diabetes mellitus is an important cardiovascular risk factor, and diabetes therapies are among the most commonly prescribed medications in the U.S. While the introduction of new, high-cost therapies has increased costs, recent trends in national spending on diabetes medications by insurance payer have not been examined. Understanding the burden of costs amongst all payers may help inform strategies to optimize drug expenditures in the US. Objective: To produce nationally representative estimates of US spending on diabetes therapies from 2007 to 2017, stratified by insurance payers (Medicare, Medicaid, Private, VA, and TRICARE—a program for civilian health benefits for US Armed Forces). Trends in out-of-pocket costs were also examined. Design/Setting: Retrospective analysis of patient-level data from the Medical Expenditure Panel Survey, a nationally representative survey that is the most complete source of data on healthcare costs in the US, from 2007 to 2017. Participants: All patients receiving one or more classes of diabetes therapies. Outcomes: Inflation-adjusted total national expenditures on all diabetes therapies. Results: There were substantial increases in total expenditures on diabetes therapies for all payers during the study period, ranging from +165.6% for VA & TRICARE ($380.6 million to $1.0 billion) to +460.4% for Medicaid ($1.1 to $6.1 billion). Private insurers increased spending by +346.6% ($5.7 to $25.5 billion), and Medicare increased spending by +389.9% ($5.4 to $25.2 billion). Out-of-pocket spending increased more modestly (+15.7%, from $4.7 to $5.7 billion). Conclusions/Relevance: Spending on diabetes therapies increased dramatically between 2007-2017, with Medicare spending increasing by 389.9%. In contrast, increases in out-of-pocket costs have been more modest. Reasons for the rapid rate of rise in Medicare and private spending compared to out-of-pocket spending should be examined in future studies.

Introduction: Infection of cardiovascular-implantable electronic devices (CIED) is a serious complication. Systemic antibiotic therapy is considered ineffective, justifying the current guidelines proposing total CEID and lead extraction. Objective: To evaluate the safety and efficacy of continuous in-situ-targeted, ultra-high concentration of antibiotics (CITA) in CIED infections limited to the subcutaneous pocket. Methods: Infected CIED were treated with CITA, delivered to the CIED pocket following minimally invasive surgery (MIS). The CIED were submerged in a 10 2 -10 3 minimal inhibition concentration (MIC) solution of vancomycin and/or gentamicin as per daily conventional dosing. Serum antibiotic levels were regulated by adjusting the concentration and flow of pocket irrigation. CIED salvage rate was assessed. Results: A total of 937 and 481serum assays of vancomycin and gentamicin, respectively, from 83 infected CIED was evaluated (Figure). Target antibiotic serum levels were obtained at 12-48 hours. Median treatment was 8 days (IQR 5,12). Parallel intravenous (IV) vancomycin treatment was applied in 6 (7%) infections. Vancomycin serum levels exceeded a trough limit of 20μg/ml in 20 (2.1%) assays, of which 19/20 received parallel IV treatment. No peak gentamicin levels were recorded. Gentamicin exceeded trough serum level reaching 2-3μg/ml in 80 (16.6%), reached potentially toxic levels of 3-5μg/ml in 33 (6.9%), and exceeded 5μg/ml in 10 (2.1%) assays. CITA resulted in a 1-year salvage of 71 (86%) CIED. Treatment failed in 12 infections, resulting in 8 uneventful total CIED extractions. The 30-day mortality rate was 2.4%. Conclusions: CITA provided ultra-high pocket antibiotic levels, with its safety confirmed by systemic level assays. CITA combined with MIS enabled salvage of 86% of infected CIED. The CITA-MIS approach may serve as an initial therapeutic option prior to the extraction of locally infected CIED, especially in high-risk patients.

Background: Antibacterial cardiovascular implantable electronic device (CIED) envelopes provide short-term local antibiotic delivery and can reduce implant site infection risk. Available antibacterial CIED envelopes are either fabricated from biologic material (extracellular matrix hydrated with antibiotics by the user) or from non-biologic material (synthetic mesh coated with antibiotics by the manufacturer). Objective: To compare the risk profiles and outcomes of CIED procedure patients receiving no envelope vs an antibacterial envelope. Methods: Records of consecutive CIED procedure patients at one center were reviewed through 12 months follow-up. Procedures used either no envelope, a biologic envelope pre-hydrated with vancomycin and gentamicin (BIO) [CanGaroo®, Aziyo Biologics], or a non-biologic envelope coated with minocycline and rifampin (Non-BIO) [TYRX™, Medtronic]. Results: CIED procedures were performed on 248 patients (191 with envelope, 89 BIO, 102 Non-BIO). Patients receiving envelopes were younger, had significantly more comorbid risk factors (p<0.001), and received high powered devices and reoperative procedures more often (p<0.001)(Table 1). BIO envelopes were used more often in higher risk patients (84% vs 78%) and reoperative patients (62% vs 38%) compared to Non-BIO envelopes. CIED implant site pocket infection rates were low (envelope 0.5%, no envelope 0%, p=0.584), with no significant difference between BIO and Non-BIO envelopes. Conclusion: Antibacterial envelopes were used more often to treat patients with multiple comorbid risk factors. Biologic envelopes were used more often in higher risk patients. There was no significant difference in CIED implant site pocket infection rates for patients receiving biologic or non-biologic antibacterial envelopes.

Background: A common mechanism for block of ion channels is current inhibition by drug binding to residues - notably in S6 - within the permeating pore. Open state block is commonly observed. Methods and Results: In this study, we used a combination of alanine/cysteine mutagenesis, patch clamp, and homology modeling to identify a novel allosteric mechanism for drug block of the human cardiac potassium channel KCNQ1 (the α-subunit encoding IKs). The initial mutagenesis experiments studied a total of 45 amino acid residues in the S6 segment (30 residues), and the proximal C-terminus (15 residues) of KCNQ1. Residues required for drug block were identified as alanine/cysteine mutants displaying <50% block of expressed current (n=4 – 6 each) upon exposure to drug concentrations inhibiting wild-type current by ≥90% (quinidine 100 μm, clofilium 30 μm and L-7 10 μm). Among the 30 residues in S6, there were five (F332, F335, S338, A341 and G348) displaying such reduced block and in the proximal C-terminus, 5/15 were less sensitive, including F351 which was near-totally resistant (current decrease = 4±3%). Homology modeling of KCNQ1 based on the Kv1.2 structure unexpectedly suggested that F351 faces away from the permeating pore, arguing against pore block as the mechanism for drug inhibition of KCNQ1 current. In the open channel model, F351 lines a pocket that also includes L251 and V254 in S4–S5. The model allows drug access to this pocket, and alanine substitutions at both sites yielded potassium currents that were resistant to drug block (↓34±4% for L251A and ↓40±5% for V254A). Conclusion: These data strongly support a model in which open state block of this channel occurs not via binding to a site in the pore but rather by a novel allosteric mechanism, drug access to a side pocket generated in the open channel configuration and lined by S6 and S4/S5 residues.

Background: Limited data exist regarding implantable cardioverter defibrillator (ICD) usage in infants and toddlers. This study evaluates ICD placement indications, procedural techniques, programming strategies, and outcomes of ICDs in infants and toddlers. Methods: This is a single-center retrospective review of all patients ≤3 years old who received an ICD from 2009 to 2021. Results: Fifteen patients received an ICD at an age of 1.2 years (interquartile range [IQR], 0.1–2.4; 12 [80%] women; weight, 8.2 kg [IQR, 4.2–12.6]) and were followed for a median of 4.28 years (IQR, 1.40–5.53) or 64.2 patient-years. ICDs were placed for secondary prevention in 12 patients (80%). Diagnoses included 8 long-QT syndromes (53%), 4 idiopathic ventricular tachycardias/ventricular fibrillations (VFs; 27%), 1 recurrent ventricular tachycardia with cardiomyopathy (7%), 1 VF with left ventricular noncompaction (7%), and 1 catecholaminergic polymorphic ventricular tachycardia (7%). All implants were epicardial, with a coil in the pericardial space. Intraoperative defibrillation safety testing was attempted in 11 patients (73%), with VF induced in 8 (53%). Successful restoration of sinus rhythm was achieved in all tested patients with a median of 9 (IQR, 7.3–11.3) J or 0.90 (IQR, 0.68–1.04) J/kg. Complications consisted of 1 postoperative chylothorax and 3 episodes of feeding intolerance. VF detection was programmed to 250 (IQR, 240–250) ms with first shock delivering 10 (IQR, 5–15) J or 1.1 (IQR, 0.8–1.4) J/kg. Three patients (20%) received appropriate shocks for ventricular tachycardia/VF. No patient received an inappropriate shock. There were 2 (13%) ventricular lead fractures (at 2.6 and 4.2 years post-implant), 1 (7%) pocket-site infection, and 2 (13%) generator exchanges. All patients were alive, and 1 patient (7%) received a heart transplant. Conclusions: ICDs can be safely and effectively placed for sudden death prevention in infants and toddlers with good midterm outcomes.

Introduction: Twiddler’s syndrome refers to deliberate or unintentional twisting of pulse generator in device pocket resulting in lead migration, which can present as malfunction of pacemaker or implantable cardioverter-defibrillator (ICD). In the past 50 years, twiddler’s syndrome with transvenous ICD and pacemaker has been well-described and thoroughly studied. However, there are very little data on twiddler’s syndrome with subcutaneous ICD (S-ICD). Case presentation: The patient is a 50-year-old male with a past medical history of hypertrophic cardiomyopathy, cardiac MRI showing left ventricular hypertrophy with a wall thickness of 24 mm, non-sustained ventricular tachycardia and evidence of late gadolinium enhancement scar, who underwent implantation of S-ICD for primary prevention. First follow-up 2 weeks post-implant showed appropriate device function. Two weeks later, remote monitor documented atrial fibrillation and ICD shocks. Surface ECG showed reduced R wave and delivered shock impedance was 7 ohms. Patient reported no symptoms and was clapping hands to music when it occurred. Chest X-Ray revealed S-ICD lead dislodged and retracted with coiling around the generator in the left lateral chest wall (Figure 1). Subsequently patient underwent lead revision and device replacement. To reduce the risk of future dislodgement, during re-implantation, the tip of the ICD lead was secured with 0-Silk. Conclusion: Twiddler’s syndrome is a rare complication after ICD implantation, not only with transvenous-ICDs but also involving S-ICDs. Risk factors include advanced and younger ages, redundant skin, obesity, oversized pocket, and psychiatric disorder. It can be a potentially dangerous and even fatal due to undetected or unsuccessful therapy for ventricular tachyarrythmias. Therefore, it is of paramount importance to diagnose and intervene early to avoid morbidity and mortality in these patients.

Introduction: The incidence of device infection is constantly increasing; requiring transvenous lead extraction (TLE). Data regarding predictors of short and long-term mortality after TLE for infection are limited. Methods: We collected data regarding 30-day and 1-year mortality of patients undergoing TLE at a university hospital between April 2004 and June 2015. Patients with less than 30-day follow up were excluded. Results: Out of total 1223 TLE procedures, 700 were performed for infectious indications. 30-day follow-up was available for 620 patients (88.6%) and 1-year follow up was available for 541 patients (77.3%). Overall 30-day mortality was 9% (4.3% for pocket infection, 12.3% for systemic infection) and 1-year mortality was 27.5% (16% for pocket infection, 35.8% for systemic infection). Patient age, end-stage renal disease, history of valve replacement, atrial fibrillation, Staphylococcus aureus infection, systemic infection, any procedural complication, elevated WBC count, low hemoglobin, need for CCU admission, need for pressor support, acute kidney injury, cardiogenic shock and need for blood transfusion were predictors of both 30-day and 1-year mortality in univariate analysis. Any retained fragment was predictor of 30-day mortality. Peripheral vascular disease and low platelet count were predictors of 1-year mortality. Patient age, history of valve replacement, need for pressor support and low hemoglobin were independent predictors of 30-day as well as 1-year mortality in multivariate analysis. End-stage renal disease, atrial fibrillation, elevated WBC count and need for CCU admission were independent predictors of 30-day mortality. Systemic infection, low platelet count and need for blood transfusion were predictors of 1-year mortality. Strongest predictor of 30-day mortality was history of valve replacement (Odds ratio 4.23) and strongest predictor of 1-year mortality was need for pressor support (Odds ratio 3.12). Conclusions: In conclusion, 30-day and 1-year mortality after device infection remains high despite successful TLE. Patient age, history of valve replacement, need for pressor support and low hemoglobin are independent predictors of both short and long-term mortality in multivariate analysis.

Introduction: Patients with continuous flow Left Ventricular Assist Devices (LVAD) and concomitant Cardiac Implantable Electrical Devices (CIED) are prone for device and lead-related complications requiring intervention. Hypothesis: We evaluated the incidence and characteristics of CIED-related procedures and complications and their association with survival in a multicenter LVAD cohort. Methods: We retrospectively reviewed data on 480 LVAD patients with a CIED from 5 centers. Of the 480, 235 patients had accurate long-term CIED follow-up data and were used for this analysis. Kaplan Meier analysis was used to assess survival differences between patients with CIED-related complications versus those who did not. Results: Of 235 patients with an LVAD and a CIED (Age 58±13, 80% male), 130 had a CRT-D and 105 had ICD only. During a median LVAD follow-up of 692 days, 103 patients required a CIED generator replacement with CRT-D patients having a significantly higher rate of generator replacement compared to the ICD only group (68[52%] vs 35[33%], p=0.003). A CIED or lead-related complication occurred in 36 (28%) of CRT-D patients and 16 (15%) of the ICD patients (p=0.06). 20 (15%) patients in the CRT-D group and 14 (13%) in the ICD group underwent lead removal or extraction during follow-up (p=0.5). Both the CRT-D and ICD groups had comparable incidences of pocket hematoma (8% vs 5%), pocket and/or lead infection (9% vs 4%), and lead malfunction (8% vs 9%). Kaplan Meier analysis showed no significant survival difference between those who had a CIED-related complication versus those who did not (log rank p= 0.7). Conclusions: CIED related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D post-LVAD resulted in a significantly higher number of generator changes and showed a trend towards higher device or lead related complications. CIED-related complications were not associated with reduced survival.

Introduction: Pseudocysts are a known complication of chronic pancreatitis, occurring in 30-40% of patients. They form when disruption of the pancreatic duct system creates fluid-filled pockets with high concentrations of digestive enzymes. Leakage of these enzymes can create pancreatic fistulas. Here, we present a case of an unusual fistula that occurred in an immunocompromised individual. Case Description: A 34-year-old man with a history of Acquired Immunodeficiency Syndrome, alcohol use disorder, and chronic pancreatitis who had recently recovered from acute pancreatitis complicated by pericardial effusion was readmitted with worsening pleuritic chest pain and shortness of breath. He was hemodynamically stable with a normal cardiopulmonary exam without jugular venous distention or pulsus paradoxus. Labs were at his baseline other than an elevated d-dimer level. Computed tomography scan revealed a large, loculated pericardial effusion with a fistula extending through the diaphragm to a large peripancreatic pseudocyst. Gastroenterology performed pancreatic ductal stenting via endoscopic retrograde cholangiopancreatography and Interventional Radiology placed a percutaneous drainage catheter to facilitate resolution of the pseudocyst. Discussion: A pancreatico-pericardial fistula is a very rare complication of chronic pancreatitis. A 2016 review detailed only fifteen cases over a 40-year span with surgical management providing the best outcomes. Given this patient’s immunocompromise and malnutrition surgery was not offered, but endoscopic stenting and percutaneous drainage allowed for successful resolution of his fistula.

Urea transport protein B, the product of the gene SLC14A1 , facilitates transport of urea, water and urea analogues across cell membranes. SLC14A1 mRNA is overexpressed in human vascular endothelial cells in culture under hypoxic (1% oxygen) conditions compared with normoxia. This leads to transport of urea out of the endothelial cell and likely contributes to the reduction in eNOS (endothelial nitric oxide synthase) pathway activity in hypoxia. NO has antiviral activity. Novel compounds were developed by binding a urea-like moiety to the backbone of the generic agent isosorbide mononitrate, a well-known NO donor, to combat vascular endothelial dysfunction in COVID-19, a disease characterized by systemic hypoxia and inflammation due to SARS-CoV-2 infection. A study of drug-protein interactions was undertaken using in silico modelling. Novel compounds were studied against 9 key SARS-CoV-2 targets using Maestro, Schrödinger Suite software (Glide docking). Docking scores and intermolecular interactions within the target’s key binding amino acid residues were studied to compare investigational compounds and known antivirals. Several novel agents tested had a better Glide Score (a prediction of ligand affinity) against the papain-like protease (PL pro ) of SARS-CoV-2 compared with known antiviral drugs. PL pro is considered to be a primary target for therapeutic inhibition of the SARS viruses. The candidate compounds CR-305, CR-607, CR-510 and CR-605 were all superior to Remdesivir, GS-441524, Lopinavir, Boceprevir, and Ribavirin. Given the known direct antiviral action of NO and evidence of specific binding of these compounds to the PL pro of SARS-CoV-2 based on the in silico results, we conclude there is a high likelihood these novel compounds will prove to be of therapeutic value against COVID-19. CR-305 appears to have a higher affinity to SARS-CoV-2 than other antivirals as it sits firmly in the PL pro catalytic pocket and makes the most of key interactions with the catalytic pocket residues: Gly163, Asp164, Gln271 and Tyr264. These data call for a new focus on these novel antiviral agents as they appear to bind with an increased avidity to PL pro (compared with other known antivirals) while targeting delivery of NO to the SARS-CoV-2 virus in COVID-19.

Introduction: In pediatric patients prevention of Sudden Cardiac Death (SCD) using Implantable Cardioverter Defibrillators (ICD) is associated with a higher risk of complications than in the adult population. Surgical re-interventions due to infection, lead dislocation or migration and inappropriate shocks on intra and extracardiac oversensing are the most prevalent complications. The Subcutaneous ICD (S-ICD) has been introduces as a less invasive and extravascular alternative to overcome some of these complications. The scientific data that has led to the approval of the S-ICD did not include pediatric patients. Contradicting reports in small cohorts have been published on the effectiveness of S-ICD therapy in the pediatric population. We here report the largest pediatric cohort with the longest follow up to date where the S-ICD has been used for SCD prevention. Hypothesis: The S-ICD is safe and effective for the prevention of SCD in a diverse pediatric population. Methods: We retrospectively studied all consecutive pediatric patients (age<18 yrs)that were implanted with a S-ICD in our center. Results: Fifteen S-ICDs were implanted in 14 patients (mean age 14, range 8-17), 71% were male, mean BMI was 18.8 (range 17.2-28.8), 57% had a secondary prevention indication, 77% had a genetic arrhythmia diagnosis and the median follow up was 21 months (range 1- 57). The first shock efficacy of induced and spontaneous episodes was 100% (n=13 and n =2 respectively). Inappropriate shocks due to intracardiac oversensing occurred in 3 (21%) patients. No lead failures or dislocations were observed. Two patients (14%) experienced a complication requiring re-intervention: one infection and one pocket erosion. After the pocket erosion the S-ICD has been successfully re-implanted. In one patient the S-ICD was removed after cardiac transplantation. None of the patients died during follow up. Conclusions: The S-ICD is safe and effective in a diverse pediatric populations. There was a very high efficacy of defibrillation therapy (100%) and a relative low and mild occurrence of complications. The S-ICD should be considered as a viable alternative for transvenous ICD's in pediatric patients.

Introduction: Tasers are electronic controlled devices used by law enforcement to temporarily incapacitate individuals. They generate high voltage, low current repetitive pulsed waveforms which may adversely affect implanted pacemakers. Methods: A single chamber Medtronic bipolar lead was placed under fluoroscopic guidance in the RV apex of 4 pigs and connected to an Adapta generator placed in pre-pectoral pocket. After anesthesia, multiple stun gun shocks were fired every 3 minutes with Taser X-26, Taser M-26 and Stinger S-200. Intracardiac electrograms were continuously recorded during the taser discharges by placing the wand over the pacemaker pocket. Results: The taser did not produce any effects on the native rhythm which is easily seen underlying the distinctive noise signature from the taser shock (Fig-1A ). The Adapta device used for this testing has atrial tachycardia detection capability, explaining the atrial sense markers appearing with the taser noise. Figure 1B was recorded when the pig was 100% paced and the stun gun fired. The reversion pacing, observed in this strip, is functionally asynchronous from the native rhythm the entire time that the taser noise is present and goes away as soon as the taser noise is removed. Conclusions: Stun Gun discharges, were recognized by the pulse generator and sensed as either high rate atrial or ventricular activity depending on which vector is more in line with the electric field created by the two taser electrodes, did not affect the native rhythm, did not conduct down the lead systems to cause any extra systoles, and had no effect on paced rhythm. The use of these devices appears safe in victims with this type of pulse generator.

Introduction: Previous studies showed that continuous anticoagulation during implantation of cardiac rhythm device (CRD) was safe. However, the safety and efficacy of continuous anticoagulant and antiplatelet combination therapy in patients undergoing CRD interventions has not been clearly defined. Hypothesis: We sought to evaluate the safety and efficacy of this therapy during implantation of CRD. Methods: A total of consecutive 300 patients (mean 68.7 years old, 171 males) underwent CRD implantation were enrolled from April 2012 to December 2012. We divided patients into Non-drug (patients without antithrombotic therapy), Single-drug (patients with anticoagulant or antiplatelet therapy), and Combination-drug (patients with anticoagulant and antiplatelet therapy) group, and evaluated the clinical outcome among 3 groups. Clinically significant hematoma was defined as device-pocket hematoma that needed prolonged hospitalization, interruption of antithrombotic therapy, surgical intervention, or blood products transfusion. Results: The number of Non-drug, Single-drug, and Combination-drug groups was 129, 139, and 32, respectively. Clinical outcome was shown in Table. Hematoma occurred significantly more in Combination-drug than Non-drug group, but occurrence of clinically significant hematoma was not different among 3 groups. Cardiac tamponade was none and thrombo-embolic event was rare. Conclusions: Continuous anticoagulant and antiplatelet combination therapy was safe and effective during implantation of CRD.

Apolipoprotein E3 (apoE3) is a 34 kDa exchangeable apolipoprotein critical for lipid transport and associates with chylomicrons, VLDL, and a subclass of HDL. The protein contains two independently folded domains: a 22 kDa N-terminal domain and a 10 kDa C-terminal domain. The N-terminal domain contains LDL receptor binding sites and is tightly folded into a 4-helix bundle. The smaller C-terminal (CT) domain contains helical segments that: (i) promote protein-protein interaction and apoE3 self-association, (ii) bear high lipid binding affinity, and, (iii) facilitate cholesterol efflux from macrophages. In contrast, insect apolipophorin III (apoLp-III) is a one-domain protein bearing a 5-helix bundle, does not self-associate and binds to diacylglycerol enriched lipoproteins. To better understand the domain organization of apolipoproteins, a chimeric protein was constructed of apoLp-III and the CT domain of apoE3 (residues 201-299). The structure and function of the 28 kDa apoLp-III/CT-apoE3 chimera was determined and compared to that of parent proteins apoLp-III and apoE3. The novel chimeric construct was expressed in E. coli and purified using an N-terminal poly-histidine tag. Electrophoresis and Western blot analysis showed that the apoLp-III/CT-apoE3 chimera was of the expected size and reacted with apoE3 specific antibodies. Circular dichroism demonstrated that the chimera was α-helical, similar to both parent proteins. While apoLp-III was monomeric, the chimera formed tetramers similar to apoE3. Probing for hydrophobic pockets on the protein surface with anilinonaphthalene-8-sulfonic acid demonstrated that the CT domain provided increased binding sites for the probe. Addition of the CT domain to apoLp-III conferred an increased ability to promote cholesterol efflux from J774 macrophages, comparable to that of parent apoE3. Thus, the fold of apoLp-III/CT-apoE3 chimera was similar to that of apoE3, promoted self-association and cholesterol efflux. This demonstrated that functional characteristics of CT domain of apoE3 can be transferred independently to another apolipoprotein, allowing us to further increase our understanding of apolipoprotein domains.

In “Dilemmas in a General Theory of Planning,” urban planners Horst Rittel and Melvin Webber outline what they term “wicked problems.” According to Rittel and Webber, wicked problems are unavoidably “ill-defined,” that is, unlike “problems in the natural sciences, which are definable and separable and may have solutions that are findable…[wicked problems] are never solved. At best they are only re-solved—over and over again” (160). Rittel and Webber were thinking specifically of the challenges involved in making decisions within immensely complex social circumstances—building highways through cities and designing low income housing projects, for example—but public policy-making and urban design are not the only fields rife with wicked problems. Indeed, the nub of Rittel and Webber’s articulation of wicked problems concerns a phenomenon common to many disciplines: interdisciplinary collaboration. As anyone who has collaborated with people outside her area of expertise will acknowledge, interdisciplinary collaboration itself is among the wickedest problems of all. By way of introduction, we direct the Learning Games Initiative (LGI), a transdisciplinary, inter-institutional research group that studies, teaches with, and builds computer games. In the seven years since LGI was inaugurated, we have undertaken many productive and well-received collaborations, including: 1) leading workshops at national and international conferences; 2) presenting numerous academic talks; 3) editing academic journals; 4) writing books, book chapters, journal articles, and other scholarly materials; 5) exhibiting creative and archival work in museums, galleries, and libraries; and 6) building one of the largest academic research archives of computer games, systems, paraphernalia, and print-, video-, and audio-scholarship in the world. We thus have a fair bit of experience with the wicked problem of collaboration. The purpose of this article is to share some of that experience with readers and to describe candidly some of the challenges we have faced—and sometimes overcome—working collaboratively across disciplinary, institutional, and even international boundaries. Collaborative Circle? Michael Farrell, whose illuminating analysis of “collaborative circles” has lent much to scholars’ understandings of group dynamics within creative contexts, succinctly describes how many such groups form: “A collaborative circle is a set of peers in the same discipline who, through open exchange of support, ideas, and criticism develop into an interdependent group with a common vision that guides their creative work” (266). Farrell’s model, while applicable to several of the smaller projects LGI has nurtured over the years, does not capture the idiosyncratic organizational method that has evolved more broadly within our collective. Rather, LGI has always tended to function according to a model more akin to that found in used car dealerships, one where “no reasonable offer will be refused.” LGI is open to anyone willing to think hard and get their hands dirty, which of course has molded the organization and its projects in remarkable ways. Unlike Farrell’s collaborative circles, for example, LGI’s collaborative model actually decentralizes the group’s study and production of culture. Any member from anywhere—not just “peers in the same discipline”—can initiate or join a project provided she or he is willing to trade in the coin of the realm: sweat equity. Much like the programmers of the open source software movement, LGI’s members work only on what excites them, and with other similarly motivated people. The “buy-in,” simply, is interest and a readiness to assume some level of responsibility for the successes and failures of a given project. In addition to decentralizing the group, LGI’s collaborative model has emerged such that it naturally encourages diversity, swelling our ranks with all kinds of interesting folks, from fine artists to clergy members to librarians. In large part this is because our members view “peers” in the most expansive way possible; sure, optical scientists can help us understand how virtual cameras simulate the real properties of lenses and research linguists can help us design more effective language-in-context tools for our games. However, in an organization that always tries to understand the layers of meaning-making that constitute computer games, such technical expertise is only one stratum. For a game about the cultural politics of ancient Greece that LGI has been working on for the past year, our members invited a musical instrument maker, a potter, and a school teacher to join the development team. These new additions—all experts and peers as far as LGI is concerned—were not merely consultants but became part of the development team, often working in areas of the project completely outside their own specialties. While some outsiders have criticized this project—currently known as “Aristotle’s Assassins”—for being too slow in development, the learning taking place as it moves forward is thrilling to those on the inside, where everyone is learning from everyone else. One common consequence of this dynamic is, as Farrell points out, that the work of the individual members is transformed: “Those who are merely good at their discipline become masters, and, working together, very ordinary people make extraordinary advances in their field” (2). Additionally, the diversity that gives LGI its true interdisciplinarity also makes for praxical as well as innovative projects. The varying social and intellectual concerns of the LGI’s membership means that every collaboration is also an exploration of ethics, responsibility, epistemology, and ideology. This is part of what makes LGI so special: there are multiple levels of learning that underpin every project every day. In LGI we are fond of saying that games teach multiple things in multiple ways. So too, in fact, does collaborating on one of LGI’s projects because members are constantly forced to reevaluate their ways of seeing in order to work with one another. This has been particularly rewarding in our international projects, such as our recently initiated project investigating the relationships among the mass media, new media, and cultural resource management practices. This project, which is building collaborative relationships among a team of archaeologists, game designers, media historians, folklorists, and grave repatriation experts from Cambodia, the Philippines, Australia, and the U.S., is flourishing, not because its members are of the same discipline nor because they share the same ideology. Rather, the team is maturing as a collaborative and productive entity because the focus of its work raises an extraordinary number of questions that have yet to be addressed by national and international researchers. In LGI, much of the sweat equity we contribute involves trying to answer questions like these in ways that are meaningful for our international research teams. In our experience, it is in the process of investigating such questions that effective collaborative relationships are cemented and within which investigators end up learning about more than just the subject matter at hand. They also learn about the micro-cultures, histories, and economies that provide the usually invisible rhetorical infrastructures that ground the subject matter and to which each team member is differently attuned. It is precisely because of this sometimes slow, sometimes tense learning/teaching dynamic—a dynamic too often invoked in both academic and industry settings to discourage collaboration—that François Chesnais calls attention to the fact that collaborative projects frequently yield more benefits than the sum of their parts suggests possible. This fact, says Chesnais, should lead institutions to value collaborative projects more highly as “resource-creating, value-creating and surplus-creating potentialities” (22). Such work is always risky, of course, and Jitendra Mohan, a scholar specializing in cross-cultural collaborations within the field of psychology, writes that international collaboration “raises methodological problems in terms of the selection of culturally-coloured items and their historical as well as semantic meaning…” (314). Mohan means this as a warning and it is heeded as such by LGI members; at the same time, however, it is precisely the identification and sorting out of such methodological problems that seems to excite our best collaborations and most innovative work. Given such promise, it is easy to see why LGI is quite happy to adopt the used car dealer’s slogan “no reasonable offer refused.” In fact, in LGI we see our open-door policy for projects as mirroring our primary object of study: games. This is another factor that we believe contributes to the success of our members’ collaborations. Commercial computer game development is a notoriously interdisciplinary and collaborative endeavor. By collaborating in a fashion similar to professional game developers, LGI members are constantly fashioning more complex understandings of the kinds of production practices and social interactions involved in game development; these practices and interactions are crucial to game studies precisely because they shape what games consist of, how they mean, and the ways in which they are consumed. For this reason, we think it foolish to refuse any reasonable offer to help us explore and understand these meaning-making processes. Wicked Problem Backlash Among the striking points that Rittel and Webber make about wicked problems is that solutions to them are usually created with great care and planning, and yet inevitably suffer severe criticism (at least) or utter annihilation (at worst). Far from being indicative of a bad solution, this backlash against a wicked problem’s solution is an integral element of what we call the “wicked problem dialectic.” The backlash against attempts to establish and nurture transdisciplinary collaboration is easy to document at multiple levels. For example, although our used car dealership model has created a rich research environment, it has also made the quotidian work of doing projects difficult. For one thing, organizing something as simple as a project meeting can take Herculean efforts. The wage earners are on a different schedule than the academics, who are on a different schedule from the artists, who are on a different schedule from the librarians. Getting everyone together in the same room at the same time (even virtually) is like herding cats. As co-directors of LGI, we have done our best to provide the membership with both synchronous and asynchronous resources to facilitate communication (e.g., conference-call enabled phones, online forums, chat clients, file-sharing software, and so on), but nothing beats face-to-face meetings, especially when projects grow complex or deadlines impend mercilessly. Nonetheless, our members routinely fight the meeting scheduling battle, despite the various communication options we have made available through our group’s website and in our physical offices. Most recently we have found that an organizational wiki makes the process of collecting and sharing notes, drawings, videos, segments of code, and drafts of writing decidedly easier than it had been, especially when the projects involve people who do not live a short distance (or a cheap phone call) away from each other. Similarly, not every member has the same amount of time to devote to LGI and its projects despite their considerable and demonstrated interest in them. Some folks are simply busier than others, and cannot contribute to projects as much as they might like. This can be a real problem when a project requires a particular skill set, and the owner of those skills is busy doing other things like working at a paying job or spending time with family. LGI’s projects are always done in addition to members’ regular workload, and it is understandable when that workload has to take precedence. Like regular exercise and eating right, the organization’s projects are the first things to go when life’s demands intrude. Different projects handle this challenge in a variety of ways, but the solutions always tend to reflect the general structure of the project itself. In projects that follow what Andrea Lunsford and Lisa Ede refer to as “hierarchical collaborations”—projects that are clearly structured, goal-oriented, and define clear roles for its participants—milestones and deadlines are set at the beginning of the project and are often tied to professional rewards that stand-in for a paycheck: recommendation letters, all-expenses-paid conference trips, guest speaking invitations, and so forth (133). Less organized projects—what Lunsford and Ede call “dialogic collaborations”—deal with time scheduling challenges differently. Inherently, dialogic collaborations such as these tend to be less hampered by time because they are loosely structured, accept and often encourage members to shift roles, and often value the process of working toward the project’s goals as highly as actually attaining them (134). The most common adaptive strategy used in these cases is simply for the most experienced members of the team to keep the project in motion. As long as something is happening, dialogic collaborations can be kept fruitful for a very long time, even when collaborators are only able to contribute once or twice a month. In our experience, as long as each project’s collaborators understand its operative expectations—which can, by the way, be a combination of hierarchical and dialogical modes—their work proceeds smoothly. Finally, there is the matter of expenses. As an institutionally unaffiliated collective, the LGI has no established revenue stream, which means project funding is either grant-based or comes out of the membership’s pockets. As anyone who has ever applied for a grant knows, it is one thing to write a grant, and another thing entirely to get it. Things are especially tough when grant monies are scarce, as they have been (at least on this side of the pond) since the U.S. economy started its downward spiral several years ago. Tapping the membership’s pockets is not really a viable funding option either. Even modest projects can be expensive, and most folks do not have a lot of spare cash to throw around. What this means, ultimately, is that even though our group’s members have carte blanche to do as they will, they must do so in a resource-starved environment. While it is sometimes disappointing that we are not able to fund certain projects despite their artistic and scholarly merit, LGI members learned long ago that such hardships rarely foreclose all opportunities. As Anne O’Meara and Nancy MacKenzie pointed out several years ago, many “seemingly extraneous features” of collaborative projects—not only financial limitations, but also such innocuous phenomena as where collaborators meet, the dance of their work and play patterns, their conflicting responsibilities, geographic separations, and the ways they talk to each other—emerge as influential factors in all collaborations (210). Thus, we understand in LGI that while our intermittent funding has influenced the dimension and direction of our group, it has also led to some outcomes that in hindsight we are glad we were led to. For example, while LGI originally began studying games in order to discover where production-side innovations might be possible, a series of funding shortfalls and serendipitous academic conversations led us to favor scholarly writing, which has now taken precedence over other kinds of projects. At the most practical level, this works out well because writing costs nothing but time, plus there is a rather desperate shortage of good game scholarship. Moreover, we have discovered that as LGI members have refined their scholarship and begun turning out books, chapters, and articles on a consistent basis, both they and the organization accrue publicity and credibility. Add to this the fact that for many of the group’s academics, traditional print-based work is more valued in the tenure and promotion economy than is, say, an educational game, an online teachers’ resource, or a workshop for a local parent-teacher association, and you have a pretty clear research path blazed by what Kathleen Clark and Rhunette Diggs have called “dialectical collaboration,” that is, collaboration marked by “struggle and opposition, where tension can be creative, productive, clarifying, as well as difficult” (10). Conclusion In sketching out our experience directing a highly collaborative digital media research collective, we hope we have given readers a sense of why collaboration is almost always a “wicked problem.” Collaborators negotiate different schedules, work demands, and ways of seeing, as well as resource pinches that hinder the process by which innovative digital media collaborations come to fruition. And yet, it is precisely because collaboration can be so wicked that it is so valuable. In constantly requiring collaborators to assess and reassess their rationales, artistic visions, and project objectives, collaboration makes for reflexive, complex, and innovative projects, which (at least to us) are the most satisfying and useful of all. References Chesnais, François. “Technological Agreements, Networks and Selected Issues in Economic Theory.” In Technological Collaboration: The Dynamics of Cooperation in Industrial Innovation. Rod Coombs, Albert Richards, Vivien Walsh, and Pier Paolo Saviotti, eds. Northampton, MA: Edward Elgar, 1996. 18-33. Clark, Kathleen D., and Rhunette C. Diggs. “Connected or Separated?: Toward a Dialectical View of Interethnic Relationships.” In Building Diverse Communities: Applications of Communication Research. McDonald, Trevy A., Mark P. Orbe, and Trevellya Ford-Ahmed, eds. Cresskill, NJ: Hampton Press, 2002. 3-25. Farrell, Michael P. Collaborative Circles: Friendship Dynamics & Creative Work. Chicago: U of Chicago P, 2001. Lunsford, Andrea, and Lisa Ede. Singular Texts/Plural Authors: Perspectives on Collaborative Writing. Carbondale: Southern Illinois UP, 1990. Mohan, Jitendra. “Cross-Cultural Experience of Collaboration in Personality Research.” Personality across Cultures: Recent Developments and Debates. Jitendra Mohan, ed. Oxford: Oxford UP, 2000. 313-335. O’Meara, Anne, and Nancy R. MacKenzie. “Reflections on Scholarly Collaboration.” In Common Ground: Feminist Collaboration in the Academy. Elizabeth G. Peck and JoAnna Stephens Mink, eds. Albany: State U of New York P, 1998. 209-26. Rittel, Horst W. J., and Melvin M. Weber. “Dilemmas in a General Theory of Planning.” Policy Sciences 4 (1973): 155-69. Citation reference for this article MLA Style Ruggill, Judd, and Ken McAllister. "The Wicked Problem of Collaboration." M/C Journal 9.2 (2006). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0605/07-ruggillmcallister.php>. APA Style Ruggill, J., and K. McAllister. (May 2006) "The Wicked Problem of Collaboration," M/C Journal, 9(2). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0605/07-ruggillmcallister.php>.

Mobile health monitoring is driving many smart health innovations. In this research, we focus on the daily physical activity and fall risk monitoring, for intelligent activity tracking and fall risk detection purpose. Physical activity is of a tremendous value to cardiac and brain health, and has been widely agreed as a metric to improve human health, foster healthy lifestyle, and mine the impacts on diverse health issues. The risk of death can actually be lowered by 20 to 30% with moderate activities for one and half an hour per week (WHO). Besides, fall risk detection is also of huge importance since each year, there are 29% of older adults having around 29 million falls and causing 7 million fall injuries (CDC). The challenge we target is how to accurately recognize diverse physical activities and fall patterns from the biomechanical dynamics sensed by the phone. More specifically, the phone sensor is leveraged to provide real-time always-on streaming of biomechanical dynamics. Then, the data is learned by a deep learning framework (long short-term memory) for activity type and fall pattern recognition. To consider real-world scenarios, the users can put the phone in either left or write waist pockets. The users have performed 9 different kinds of activities such as walking, standing up, going upstairs and jumping, as well as 8 different kinds of fall patterns such as falling backward, sitting and falling, and falling forward with protection. A total of 11,770 activities performed by 30 subjects aging from 18 to 60 have been used to evaluate the framework, yielding an accuracy as high as 95.4%. This encouraging result shows the potential of the mobile monitor in real-world application scenarios.