Abstract Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both ...operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
Cumulative anthropogenic impacts such as overfishing, and climate change are placing marine ecosystems under increasing pressure. This includes the loss or degradation of marine habitats and ...reductions in fish stocks, with conservation and fisheries management strategies aiming to mitigate, or reverse the effects. Measuring the effectiveness of management actions on fish requires accurate data on the abundance and size of fishes. Diver operated stereo-video systems (stereo-DOVs) have become a widely accepted method for surveying reef fish but have known biases and constraints. A new generation of small and affordable remotely operated vehicles (ROVs) can carry a stereo-video system to collect reef fish data without the need for divers. However, before ROVs are adopted there is a need to understand how they compare to other conventional survey methods. We compared how stereo-DOVs and stereo-ROVs influenced fish behaviour and sampled coral reef fish assemblages inside and outside sanctuary zones in the Ningaloo Marine Park, Northern Western Australia. In general, the numbers of species, individuals and the assemblage composition did not differ significantly between survey techniques and detected consistent patterns in the assemblage composition across locations and inside and outside sanctuary zones. Both methods recorded similar proportions of length measurements (68% and 70% for stereo-DOV and stereo-ROV respectively). Fishes were significantly more wary and exhibited more flight responses towards stereo-DOVs when compared to stereo-ROVs. The use of ROVs has the potential to be a cost-effective method of surveying reef fish while eliminating the health and safety risks involved with SCUBA diving. Given the comparable metrics as well as reduced behavioural bias and logistical advantages of using stereo-ROVs, we recommend stereo-ROVs as a viable alternative to stereo-DOVs surveys.
•Fish assemblage composition sampled Stereo-DOVs and stereo-ROV was similar.•Both techniques record similar numbers of species and fish individual.•Fish allowed the Stereo-ROVs to approach them closer than stereo-DOVs.•Stereo-ROV is a cost-effective alternative to stereo-DOVs.•Stereo-ROV can operate deeper, with less health and safety risks then stereo-DOVS.
Summary
Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal and distal landing ...zones for stent-graft anchoring. Many aortic pathologies affect in the immediate proximity of the left subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre has the potential for immediate and delayed neurological and vascular symptoms. Some authors, therefore, propose prophylactic revascularisation of the LSA by transposition or bypass, while others suggest prophylactic revascularisation only under certain conditions, and still others see no requirement for prophylactic revascularisation in anticipation of LSA ostium coverage. In this review about LSA revascularisation in TEVAR patients with coverage of the LSA, we searched the electronic databases MEDLINE and EMBASE historically until the end date of May 2010 with the search terms left subclavian artery, covering, endovascular, revascularisation and thoracic aorta. We have gathered the most complete scientific evidence available used to support the various concepts to deal with this issue. After a review of the current available literature, 23 relevant articles were found, where we have identified and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals abnormal supra-aortic vascular anatomy or pathology. We further conclude that elective patients undergoing planned coverage of the LSA during TEVAR should receive prophylactic LSA transposition or LSA-to-left-common-carotid-artery (LCCA) bypass surgery to prevent severe neurological complications, such as paraplegia or brain stem infarction.
Attention deficit and hyperactivity disorder (ADHD) is a neurodevelopmental disorder, which is characterized by inattention, hyperactivity and impulsive behaviors. In particular, children have ...difficulty keeping still exhibiting increased fine and gross motor activity. This paper focuses on analyzing the data obtained from two tri-axial accelerometers (one on the wrist of the dominant arm and the other on the ankle of the dominant leg) worn during school hours by a group of 22 children (11 children with ADHD and 11 paired controls). Five of the 11 ADHD diagnosed children were not on medication during the study. The children were not explicitly instructed to perform any particular activity but followed a normal session at school alternating classes of little or moderate physical activity with intermediate breaks of more prominent physical activity. The tri-axial acceleration signals were converted into 2D acceleration images and a Convolutional Neural Network (CNN) was trained to recognize the differences between non-medicated ADHD children and their paired controls. The results show that there were statistically significant differences in the way the two groups moved for the wrist accelerometer (
-test
-value <0.05). For the ankle accelerometer statistical significance was only achieved between data from the non-medicated children in the experimental group and the control group. Using a Convolutional Neural Network (CNN) to automatically extract embedded acceleration patterns and provide an objective measure to help in the diagnosis of ADHD, an accuracy of 0.875 for the wrist sensor and an accuracy of 0.9375 for the ankle sensor was achieved.
The mono-continuum advection-dispersion equation (mADE) is commonly regarded as unsuitable for application to media that exhibit rapid breakthrough and extended tailing associated with diffusion ...between high and low permeability regions. This paper demonstrates that the mADE can be successfully used to model such conditions if certain issues are addressed. First, since hydrodynamic dispersion, unlike molecular diffusion, cannot occur upstream of the contaminant source, models must be formulated to prevent “back-dispersion.” Second, large variations in aquifer permeability will result in differences between volume-weighted average concentration (resident concentration) and flow-weighted average concentration (flux concentration). Water samples taken from wells may be regarded as flux concentrations, while soil samples may be analyzed to determine resident concentrations. While the mADE is usually derived in terms of resident concentration, it is known that a mADE of the same mathematical form may be written in terms of flux concentration. However, when solving the latter, the mathematical transformation of a flux boundary condition applied to the resident mADE becomes a concentration type boundary condition for the flux mADE. Initial conditions must also be consistent with the form of the mADE that is to be solved. Thus, careful attention must be given to the type of concentration data that is available, whether resident or flux concentrations are to be simulated, and to boundary and initial conditions. We present 3-D analytical solutions for resident and flux concentrations, discuss methods of solving numerical models to obtain resident and flux concentrations, and compare results for hypothetical problems. We also present an upscaling method for computing “effective” dispersivities and other mADE model parameters in terms of physically meaningful parameters in a diffusion-limited mobile–immobile model. Application of the latter to previously published studies of systems that exhibit early breakthrough and extended tailing shows that the upscaled mADE model is able to describe the observed behavior with reasonable accuracy given only known physical parameters for the systems without any model calibration.
•The advection-dispersion equation can describe tailing due to “back-diffusion” if the following issues are addressed:•Boundary conditions are formulated to distinguish between resident and flux concentrations•Non-physical dispersion is not allowed to occur upstream of contaminant sources•Upscaled longitudinal dispersivity can be estimated from physically-based mobile–immobile model parameters without calibration
The structure and vibrational spectroscopy of 2,5-diiodothiophene have been described for the first time. The structure is remarkable in that, despite the presence of eight molecules in the unit ...cell, there is almost no evidence for any interaction between them. This is reflected in the spectra that show coincident modes in the infrared, Raman, and inelastic neutron scattering (INS) spectra and almost resolution-limited line widths in the INS spectrum, showing that both the factor group splitting and the phonon dispersion are very small. This property has led to the use of the compound as a calibrant in INS spectroscopy. The deductions from the spectra are confirmed by a periodic density functional theory (DFT) calculation that allows a complete spectral assignment to be made. Comparison to the INS and Raman spectra of polythiophene (for which 2,5-diiodothiophene may be used as a monomer) shows a marked similarity for the former and a marked difference to the latter. The INS spectrum of polythiophene is dominated by the C–H bending modes, which are unchanged on polymerization. In contrast, the Raman spectrum of polythiophene is dominated by the changed electronic environment that results in strong electron–phonon coupling and a significant upshift of the CC stretch modes.
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