More on 'universal' versus 'selected' screening for thrombophilia: the hidden costs of false-positive diagnosis - response to Favaloro and Keeling

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Solution to the problem of the poor cyclic fatigue resistance of bulk metallic glasses

The recent development of metallic glass-matrix composites represents a particular milestone in engineering materials for structural applications owing to their remarkable combination of strength and toughness. However, metallic glasses are highly susceptible to cyclic fatigue damage, and previous attempts to solve this problem have been largely disappointing. Here, we propose and demonstrate a microstructural design strategy to overcome this limitation by matching the microstructural length scales (of the second phase) to mechanical crack-length scales. Specifically, semisolid processing is used to optimize the volume fraction, morphology, and size of second-phase dendrites to confine any initial deformation (shear banding) to the glassy regions separating dendrite arms having length scales of ≈2 μm, i.e., to less than the critical crack size for failure. Confinement of the damage to such interdendritic regions results in enhancement of fatigue lifetimes and increases the fatigue limit by an order of magnitude, making these “designed” composites as resistant to fatigue damage as high-strength steels and aluminum alloys. These design strategies can be universally applied to any other metallic glass systems

The Ultrasensitivity of Living Polymers

Synthetic and biological living polymers are self-assembling chains whose chain length distributions (CLDs) are dynamic. We show these dynamics are ultrasensitive: even a small perturbation (e.g. temperature jump) non-linearly distorts the CLD, eliminating or massively augmenting short chains. The origin is fast relaxation of mass variables (mean chain length, monomer concentration) which perturbs CLD shape variables before these can relax via slow chain growth rate fluctuations. Viscosity relaxation predictions agree with experiments on the best-studied synthetic system, alpha-methylstyrene.Comment: 4 pages, submitted to Phys. Rev. Let

A new approach to wind energy: Opportunities and challenges

Despite common characterizations of modern wind energy technology as mature, there remains a persistent disconnect between the vast global wind energy resource—which is 20 times greater than total global power consumption—and the limited penetration of existing wind energy technologies as a means for electricity generation worldwide. We describe an approach to wind energy harvesting that has the potential to resolve this disconnect by geographically distributing wind power generators in a manner that more closely mirrors the physical resource itself. To this end, technology development is focused on large arrays of small wind turbines that can harvest wind energy at low altitudes by using new concepts of biology-inspired engineering. This approach dramatically extends the reach of wind energy, as smaller wind turbines can be installed in many places that larger systems cannot, especially in built environments. Moreover, they have lower visual, acoustic, and radar signatures, and they may pose significantly less risk to birds and bats. These features can be leveraged to attain cultural acceptance and rapid adoption of this new technology, thereby enabling significantly faster achievement of state and national renewable energy targets than with existing technology alone. Favorable economics stem from an orders-of-magnitude reduction in the number of components in a new generation of simple, mass-manufacturable (even 3D-printable), vertical-axis wind turbines. However, this vision can only be achieved by overcoming significant scientific challenges that have limited progress over the past three decades. The following essay summarizes our approach as well as the opportunities and challenges associated with it, with the aim of motivating a concerted effort in basic and applied research in this area

Oral contraceptives, hormone replacement therapy, thrombophilias and risk of venous thromboembolism: a systematic review The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) Study

Combined oral contraceptives,oral hormone replacement therapy and thrombophilias are recognised risk factors for venous thromboembolism in women.The objective of this study was to assess the risk of thromboembolism among women with thrombophilia who are taking oral contraceptives or hormone replacement therapy, conducting a systematic review and metaanalysis. Of 201 studies identified, only nine met the inclusion criteria. Seven studies included pre-menopausal women on oral contraceptives and two studies included peri-menopausal women on hormone replacement therapy. For oral contraceptive use, significant associations of the risk of venous thromboembolism were found in women with factor V Leiden (OR 15.62; 95%CI 8.66 to 28.15); deficiencies of antithrombin (OR 12.60; 95%CI 1.37 to 115.79), protein C (OR 6.33; 95%CI 1.68 to 23.87), or protein S (OR 4.88; 95%CI 1.39 to 17.10), elevated levels of factor VIIIc (OR 8.80; 95%CI 4.13 to 18.75); and factor V Leiden and prothrombin G20210A (OR 7.85; 95%CI 1.65 to 37.41). For hormone replacement therapy, a significant association was found in women with factor V Leiden (OR 13.16; 95%CI 4.28 to 40.47).Although limited by the small number of studies, the findings of this study support the presence of interaction between thrombophilia and venous thromboembolism among women taking oral contraceptives. However, further studies are required to establish with greater confidence the associations of these, and other, thrombophilias with venous thromboembolism among hormone users

Recipients of electric-powered indoor/outdoor wheelchairs provided by a National Health Service: A cross-sectional study

This is the post-print version of the final paper published in Archives of Physical Medicine and Rehabilitation. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2013 by the American Congress of Rehabilitation Medicine.OBJECTIVE: To describe the characteristics, across all ages, of powered wheelchair users and the assistive technology prescribed by a regional specialist wheelchair service DESIGN: Cross-sectional study SETTING: Regional wheelchair service provided to those fulfilling strict eligibility criteria by a National Health Service serving a population of 3 million. PARTICIPANTS: 544 Electric Powered Indoor/outdoor wheelchair (EPIOC) users. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Demographic, clinical/diagnostic details of EPIOC recipients including pain, (kypho)scoliosis and ventilators. Technical features including specialised (adaptive) seating (SS), tilt in space (TIS), and modified control systems. Factors were related to age groups: 1 (0-15), 2 (16-24), 3 (25-54), 4 (55-74) and 5 (75+). RESULTS: 262 men mean age 41.7 (range 8-82, sd 20.7) and 282 women mean age 47.2 (range 7-92, sd 19.7) years were studied. Neurological/neuromuscular conditions predominated (81%) with cerebral palsy (CP) (18.9%) and multiple sclerosis (16.4%). Conditions presenting at birth or during childhood constituted 39%. 99 had problematic pain, 83 a (kypho)scoliosis and 11 used ventilators. SS was provided to 169 users (31%), the majority had CP or muscular dystrophy. TIS was used by 258 (53%). Younger people were more likely to receive TIS than older ones. Only 92 had SS and TIS, mean age 29 (range 8-72, sd 17.8) years. 52 used modified control systems. CONCLUSIONS: The diversity of EPIOC users across age and diagnostic groups is shown. Their complex interrelationships with these technical features of EPIOC prescription are explored. Younger users were more complex due to age-related changes. This study provides outcomes of the EPIOC prescription for this heterogeneous group of very severely disabled people

Using Group Model Building to Understand Factors That Influence Childhood Obesity in an Urban Environment

Background: Despite increased attention, conventional views of obesity are based upon individual behaviors, and children and parents living with obesity are assumed to be the primary problem solvers. Instead of focusing exclusively on individual reduction behaviors for childhood obesity, greater focus should be placed on better understanding existing community systems and their effects on obesity. The Milwaukee Childhood Obesity Prevention Project is a community-based coalition established to develop policy and environmental change strategies to impact childhood obesity in Milwaukee, Wisconsin. The coalition conducted a Group Model Building exercise to better understand root causes of childhood obesity in its community. Methods: Group Model Building is a process by which a group systematically engages in model construction to better understand the systems that are in place. It helps participants make their mental models explicit through a careful and consistent process to test assumptions. This process has 3 main components: (1) assembling a team of participants; (2) conducting a behavior-over-time graphs exercise; and (3) drawing the causal loop diagram exercise. Results: The behavior-over-time graph portion produced 61 graphs in 10 categories. The causal loop diagram yielded 5 major themes and 7 subthemes. Conclusions: Factors that influence childhood obesity are varied, and it is important to recognize that no single solution exists. The perspectives from this exercise provided a means to create a process for dialogue and commitment by stakeholders and partnerships to build capacity for change within the community

Yielding and irreversible deformation below the microscale: Surface effects and non-mean-field plastic avalanches

Nanoindentation techniques recently developed to measure the mechanical response of crystals under external loading conditions reveal new phenomena upon decreasing sample size below the microscale. At small length scales, material resistance to irreversible deformation depends on sample morphology. Here we study the mechanisms of yield and plastic flow in inherently small crystals under uniaxial compression. Discrete structural rearrangements emerge as series of abrupt discontinuities in stress-strain curves. We obtain the theoretical dependence of the yield stress on system size and geometry and elucidate the statistical properties of plastic deformation at such scales. Our results show that the absence of dislocation storage leads to crucial effects on the statistics of plastic events, ultimately affecting the universal scaling behavior observed at larger scales.Comment: Supporting Videos available at http://dx.plos.org/10.1371/journal.pone.002041

A living systematic review and meta-analysis characterising treatment regimes, clinical outcomes and complications associated with extracorporeal life support (ELS) for critical COVID-19 in women in pregnancy and the puerperium compared to non-pregnant women of reproductive age and comparing materno-fetal outcomes to pregnant women without COVID-19

Review question 1. To characterise the prevalence, treatment regimes, clinical outcomes and complications of COVID-19-related extracorporeal life support (ELS) as therapy for women in pregnancy/ puerperium compared to non-pregnant women of reproductive age with COVID-19. 2. To characterise maternal and fetal clinical outcomes for pregnant and puerperal patients with critical COVID-19-managed by ELS compared to pregnant women without COVID-19