This study proposes a novel transformerless single-phase three-wire line-interactive uninterruptible power supply (UPS). This UPS comprises a three-leg power converter with series-connected DC ...capacitors, a decoupling circuit, a filter inductor set, a filter capacitor set, a battery set, a switch set and a digital signal processor. The first and the second power electronic legs are controlled to generate a set of mixed currents, containing DC and AC components, to perform the functions of charging/discharging battery set, active power filter (APF) and an inverter. The third power electronic leg is controlled to generate an AC current to serve as an APF and an inverter. When the utility is in the normal condition, the power converter will charge the battery set and serve as an APF. When the utility fails, the power converter will generate a sinusoidal voltage to supply the uninterrupted power to the critical loads. A prototype is developed and tested, to verify the performance of the proposed UPS. The experimental results show that, the proposed UPS has the expected performance.
Surgeons-in-training learning how to perform cleft surgery should not only acquire a broad repertoire of technical details but also master the proper execution of techniques based on the modern ...principles of bilateral cleft lip repair with synchronous reconstruction of cleft nose deformity. This article describes a bilateral complete cleft lip repair by adopting these principles, plus a modified composition of mucosal flaps for the nasal floor and intraoral linings, including the prolabial mucosal flap, C-flap mucosal flap, inferior turbinate mucosal flap, and lateral nasal mucosal flap. The accompanying four-part video series presents the step-by-step approach for design and execution of this alternative technique.
•Water-saturated MEPCM layers were used as the thermal management medium for PV modules.•Their thermal and electrical performances were explored via CFD technique.•Incorporating the water-saturated ...MEPCM can improve the performances.•A MEPCM melting point and layer thicknesses was recommended for practical use.
The use of a water-saturated microencapsulated phase change material (MEPCM) layer as a passive thermal management medium for a building-integrated photovoltaic (BIPV) was modeled by CFD numerical simulation to explore the effects of different MEPCM melting points and MEPCM layer thicknesses on the thermal and electrical performance. The well-designed BIPV can hopefully remain at a relatively low temperature during peak sunshine hours due to the absorption of latent heat during the phase change of the MEPCM layer, which reduces the decrease in electric generation efficiency caused by the increase in temperature due to solar radiation, thereby enhancing the electric generation efficiency. The results showed that a BIPV integrated with a MEPCM layer produced a significant improvement in the thermal and electrical performance compared to an untreated PV module. Under local summer climatic conditions, a melting point of 30°C and a 3-cm-thick MEPCM (using paraffin as the core material) layer are recommended for the thermal management medium.
The evolution of flight in feathered dinosaurs and early birds over millions of years required flight feathers whose architecture features hierarchical branches. While barb-based feather forms were ...investigated, feather shafts and vanes are understudied. Here, we take a multi-disciplinary approach to study their molecular control and bio-architectural organizations. In rachidial ridges, epidermal progenitors generate cortex and medullary keratinocytes, guided by Bmp and transforming growth factor β (TGF-β) signaling that convert rachides into adaptable bilayer composite beams. In barb ridges, epidermal progenitors generate cylindrical, plate-, or hooklet-shaped barbule cells that form fluffy branches or pennaceous vanes, mediated by asymmetric cell junction and keratin expression. Transcriptome analyses and functional studies show anterior-posterior Wnt2b signaling within the dermal papilla controls barbule cell fates with spatiotemporal collinearity. Quantitative bio-physical analyses of feathers from birds with different flight characteristics and feathers in Burmese amber reveal how multi-dimensional functionality can be achieved and may inspire future composite material designs.
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•A cortex/medulla composite beam organization allows rachides to adapt flexibly•Polarized adhesion and keratin expression lead to hooklet barbules that form vanes•With-dermal papilla WNT signaling controls barbule shape along the feather P-D axis•3D feathers embedded in amber show primitive vanes formed by overlapping barbules
The design and developmental paradigms of flight feathers are explored using a combination of bio-physical analyses, molecular characterization, and evolutionary comparisons across a broad range of birds with different flight modes, revealing a modular architectural design that can accommodate diverse eco-spaces.
This manuscript describes our experience in early identifying MDR-TB cases in high-risk populations by setting up a single-referral molecular diagnosis laboratory in Taiwan. Taiwan Centers for ...Disease Control designated a single-referral laboratory to provide the GenoType MTBDR
plus
test for screening high-risk MDR-TB populations nationwide in 2012–2015. A total of 5,838 sputum specimens from 3,308 patients were tested within 3 days turnaround time. Compared with the conventional culture and drug susceptibility testing, the overall performance of the GenoType MTBDR
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test for detecting TB infection showed accuracy of 70.7%, sensitivity of 85.9%, specificity of 65.7%, positive predictive value of 45.5%, and negative predictive value of 93.3%. And the accuracy of detecting rifampin (RIF) resistance, isoniazid (INH) resistance, and MDR-TB (resistant to at least RIF and INH) were 96.5%, 95.2%, and 97.7%, respectively. MDR-TB contacts presented a higher rate of mutated codons 513–519, GenoType MTBDR
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banding pattern:
rpoB
WT3(−), and
rpoB
WT4(−) than the treatment failure group. The MDR-TB contact group also had a higher rate of
inhA
C15T mutation, banding pattern:
inh
A WT1(−), and
inhA
MUT1(+) than the recurrent group. Resistance profiles of MDR-TB isolates also varied geographically. The referral molecular diagnosis system contributed to rapid detection and initiation of appropriate therapy.
Patients with cleft lip and palate have functional and esthetic impairment and typically require multiple interventions in their life. Long-term evaluation following a treatment protocol, especially ...for patients with complete bilateral cleft lip and palate (BCLP), is important but was rarely reported in the literature.
A retrospective review was conducted on all patients with complete BCLP born between 1995 and 2002 and treated at our center. Inclusion criteria were having adequate medical records and receiving continuous multidisciplinary team care at least until 20 years of age. Exclusion criteria were lack of regular follow-up and congenital syndromic abnormalities. The medical records and photos were reviewed, and facial bone development was evaluated using cephalometric analysis.
A total of 122 patients were included, with a mean age of 22.1 years at the final evaluation in this study. Primary one-stage cheiloplasty was performed in 91.0% of the patients, and 9.0% underwent two-stage repair with an initial adhesion cheiloplasty. All patients underwent two-flap palatoplasty at an average of 12.3 months. Surgical intervention for velopharyngeal insufficiency was required in 59.0% of patients. Revisional lip/nose surgery was performed in 31.1% during growing age and in 64.8% after skeletal maturity. Orthognathic surgery was applied in 60.7% of patients with retruded midface, of which 97.3% underwent two-jaw surgery. The average number of operations to complete the treatment was 5.9 per patient.
Patients with complete BCLP remain the most challenging group to treat among the cleft. This review revealed certain suboptimal results, and modifications have been made to the treatment protocol. Longitudinal follow-up and periodic assessment help to establish an ideal therapeutic strategy and improve overall cleft care.
Long-term care facilities (LTCFs) are a potentially important reservoir of multidrug-resistant (MDR) organisms; however, limited data exist.
A point-prevalence study was conducted in four co-located ...LTCFs in Australia. Nasal and rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and MDR Gram-negative bacilli (GNB). Molecular typing and resistance detection were performed. Risk factors for colonization with an MDR organism were determined using a nested case-control study.
Consent was obtained from 115 (85%) of 136 eligible participants. Forty-one (36%) residents carried at least one type of MDR organism. The prevalence was 16% MRSA (n = 18), 6% VRE (n = 7) and 21% MDR GNB n = 24; including extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (n = 12) and Acinetobacter baumannii (n = 6). The majority of ESBL-producing E. coli and A. baumannii were clonal. Current wound management adjusted OR (AOR) 8.81 (95% CI 2.78-27.94), P < 0.001, medical device in situ AOR 5.58 (95% CI 1.34-23.32), P = 0.018 and pressure ulcer AOR 3.69 (95% CI 1.06-12.86), P = 0.04 were independent risk factors for MDR organism colonization. Advanced dementia AOR 3.54 (95% CI 1.23-10.23), P = 0.02 and prolonged antibiotic use AOR 2.95 (95% CI 1.01-8.60), P = 0.047 were independently associated with MRSA colonization, whilst current wound management AOR 15.59 (95% CI 4.85-50.10), P < 0.001 and fluoroquinolone use AOR 4.27 (95% CI 1.20-15.25), P = 0.025 were risk factors for MDR GNB colonization.
LTCFs are an important reservoir of MDR organisms, with person-to-person transmissions being a potential issue. We have identified several predictors of colonization with MDR organisms, allowing a more targeted management of high-risk residents.
Breast cancer is considered to display a high degree of intratumor heterogeneity, without any obvious morphological and pathological steps to define sequential evolution, and its progression may vary ...among individual tumors. In an attempt to elucidate these etiological and phenotypic complexities, the present study, based on the fundamental concept that genomic instability is the engine of both tumor progression and tumor heterogeneity, was conducted to test the hypothesis that breast cancer pathogenesis is driven by double-strand break (DSB)-initiated chromosome instability (CIN). The rationale underlying this hypothesis is derived from the clues provided by family breast cancer syndromes, in which susceptibility genes, including p53, ATM, BRCA1 and BRCA2, are involved within the common functional pathway of DSB-related checkpoint/ repair. Because genomic deletion caused by DSB is reflected in the genetic mechanism of loss of heterozygosity (LOH), this genome-wide LOH study was conducted, using 100 tumors and 400 microsatellite markers. To minimize the effect of heterogeneity within tumors, the experimental technique of laser capture microdissection was used to ensure that genetic and phenotypic examinations were based on the same tumor cells. Support for our hypothesis comes from the observations that: (a) the extent of DSB-initiated CIN in tumors significantly increased as tumors progressed to poorer grades or later stages; (b) in the sequential steps toward CIN, the loci of p53 and ATM, the key checkpoint genes against DSB, were lost at the earliest stage; and (c) many loci identified to be important in breast tumorigenesis were the genomic sites possibly harboring the genes involved in DSB-related checkpoint/repair (including RAD51, RAD52, and BRCA1) or CIN (including FA-A, FA-D, and WRN), and a higher number of these loci showing LOH was significantly associated with increased level of DSB-initiated CIN (P < 0.0001). Breast cancers are thus considered to be sequentially progressive with CIN. However, CIN might also cause genetic heterogeneity, which was revealed by the findings that LOH at some markers was observed only in the component of ductal carcinoma in situ but not in the invasive component of the same tumors. In addition, some markers were found to preferentially lose at specific tumor grades, implying their contribution to genetic heterogeneity during tumor development. Therefore, this study suggests that breast cancer progression is clonal with regard to CIN, but different breast cancers would present distinct molecular profiles resulting from genetic heterogeneity caused by CIN.
ABSTRACTSkeletofacial reconstruction in skeletally mature patients with cleft lip/palate can be challenging because of multifaceted condition-specific anatomical features in addition to several ...repercussions from surgical intervention during the growing period. This surgical report presents the history and evolving philosophy of cleft-skeletofacial reconstruction at the Chang Gung Craniofacial Center, a referral center for cleft care in Taiwan. The maximization of satisfactory function and the appearance outcome-burden ratio have been the fundamental aims for this team to develop and upgrade cleft-skeletofacial reconstruction over the past 4 decades, with more than 10,000 mature patients treated. The study highlights key lessons learned in outcome-based and patient-oriented changes over time until the current approach, which focuses on patient-centered care with a comprehensive, multidisciplinary, and team-based model. Substantial advances in surgical, orthodontic, anesthetic, and computer imaging aspects have contributed to improving and optimizing the correction of a broad spectrum of facial and occlusal deformities while ensuring safety, predictability, efficiency, and stability in outcomes. Understanding the development and refinement of cleft-skeletofacial reconstruction over the time and transferring these time-tested and scientifically validated protocols and principles to clinical practice may serve as a reliable foundation to continue the advancement and enhancement of the delivery of surgical cleft care worldwide.
Three-dimensional computer-assisted orthognathic surgery allows to simulate the space between the mandibular ramus segments, i.e. intersegmental gap, for the correction of facial asymmetry. The ...purposes of the study were to estimate the screws- and mandible bone-related changes from the early postoperative period to the period after the debonding and to measure the association between the intersegmental gap volume and the screws- and mandible bone-related changes.
This cone-beam computed tomography (CBCT)-assisted retrospective study assessed the stability of the bicortical positional screw fixations in maintaining the space between the mandibular ramus segments after bilateral sagittal split osteotomy in correction of 31 patients with malocclusion and facial asymmetry. The primary predictor variable was the CBCT-based intersegmental gap volume at early postoperative period (T1). The primary outcome variables were CBCT-based screws- and bone-related measurement changes between the T1 and T2 (at debonding) periods.
No significant differences were observed in screws-related linear and angular measurements between T1 and T2 virtual models. Some of mandible bone-related linear and angular measurements had significant differences (P < 0.05) between the T1 and T2 images, but with no clinical repercussion such as need of revisionary surgery. The gap volume and the screws- and bone-related changes had no significant correlations.
This study contributes to the multidisciplinary-related literature by demonstrating that the bicortical positional screws-based fixation technique in maintaining the three-dimensional-simulated space between the mandibular ramus segments is a stable and clinically acceptable option for correction of facial asymmetry associated with malocclusion, regardless of intersegmental gap size.
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