The Role of Growth Trajectories in Classifying Fetal Growth Restriction

OBJECTIVE: To examine the validity of a growth trajectory method to discriminate between pathologically and constitutionally undergrown fetuses using repeated measures of estimated fetal weight.

METHODS: In a prospective, observational, multicenter study in Ireland, 1,116 women with a growth-restricted fetus diagnosed participated with the objective of evaluating ultrasound findings as predictors of pediatric morbidity and mortality. Fetal growth trajectories were based on estimated fetal weight.

RESULTS: Between 22 weeks of gestation and term, two fetal growth trajectories were identified: normal (96.7%) and pathologic (3.3%). Compared with the normal trajectory, the pathologic trajectory was associated with an increased risk for preeclampsia (odds ratio [OR] 8.1, 95% confidence interval [CI] 2.6–23.4), increased umbilical artery resistance at 30 weeks of gestation (OR 12.6, 95% CI 4.6–34.1) or 34 weeks of gestation (OR 28.0, 95% CI 8.9–87.7), reduced middle cerebral artery resistance at 30 weeks of gestation (OR 0.33, 95% CI 0.12–0.96) or 34 weeks of gestation (OR 0.14, 95% CI 0.03–0.74), lower gestational age at delivery (mean 32.02 weeks of gestation compared with 38.02 weeks of gestation; P<.001), and higher perinatal complications (OR 21.5, 95% CI 10.5–44.2). In addition, 89.2% of newborns with pathologic fetal growth were admitted to neonatal intensive care units compared with 25.9% of those with normal growth.

CONCLUSIONS: Fetal growth trajectory analysis reliably differentiated fetuses with a pathologic growth pattern among a group of women with growth-restricted fetuses. With further development, this approach could provide clarity to how we define, identify, and ultimately manage pathologic fetal growth.

LEVEL OF EVIDENCE: II

Microneedles for intradermal and transdermal drug delivery

The formidable barrier properties of the uppermost layer of the skin, the stratum corneum, impose significant limitations for successful systemic delivery of broad range of therapeutic molecules particularly macromolecules and genetic material. Microneedle (MN) has been proposed as a strategy to breach the stratum corneum barrier function in order to facilitate effective transport of molecules across the skin. This strategy involves use of micron sized needles fabricated of different materials and geometries to create transient aqueous conduits across the skin. MN, alone or with other enhancing strategies, has been demonstrated to dramatically enhance the skin permeability of numerous therapeutic molecules including biopharmaceuticals either in vitro, ex vivo or in vivo experiments. This suggested the promising use of MN technology for various possible clinical applications such as insulin delivery, transcutaneous immunisations and cutaneous gene delivery. MN has been proved as minimally invasive and painless in human subjects. This review article focuses on recent and future developments for MN technology including the latest type of MN design, challenges and strategies in MNs development as well as potential safety aspects based on comprehensive literature review pertaining to MN studies to date. (C) 2013 Elsevier B.V. All rights reserved.

Evaluation of Cyclic Deformation Behavior of Laser-welded Shape Memory NiTi Alloys at Different Working Temperatures

Post-weld heat-treatment (PWHT) has been established as one of the cost-effective ways to improve the functional properties, namely shape memory and super-elastic effects (SME and SE), of laser-welded NiTi alloys. However, the functional performance of the laser-welded joint at different working temperatures has not been explored yet. The purpose of this study is to investigate the effect of different working temperatures on the functional properties of the laser-welded NiTi alloys before and after PWHT by applying cyclic deformation tests. Two laser-welded samples: as-welded and heat-treated sample (after PWHT at 350 oC or 623 K) were tested in this work at room temperature, 50 oC (or 323 K) and 75 oC (or 348 K) respectively. The samples were cyclically loaded and unloaded for 10 cycles up to 4 % strain. The critical stress to induce the martensitic transformation and the residual strain after the cyclic tests were recorded. The results indicate that the heat-treated sample exhibited better functional properties than the as-welded sample at room temperature and 50 oC (or 323 K). However, both the as-welded and heat-treated samples failed in the cyclic tests at 75 oC (or 348 K). These findings are important to determine the feasible working temperature range for the laser-welded NiTi components to exhibit desirable functional properties in engineering applications involving cyclic loading.

Replacing the ASBO with the injunction to prevent nuisance and annoyance: a plea for legislative scrutiny and amendment

In May 2013, the Coalition Government introduced a Bill which if passed will streamline the tools available to tackle anti-social behaviour. One of their proposals is to replace the controversial anti-social behaviour order (ASBO) with what is termed an Injunction to Prevent Nuisance and Annoyance (IPNA). Although designed to tackle criminal and sub-criminal behaviour, this new intervention will be a purely civil order replacing the civil-criminal hybrid ASBO. This article explores some of the more troubling aspects of this part of the Bill including its expansive definition of anti-social behaviour, the avoidance of due process protections, the extensive restrictions that respondents may face and the likely impact of its use on young people. With legislation presently under Parliamentary scrutiny, this article calls for amendments to avoid the most problematic aspects of the ASBO being not just replicated but amplified.

Correlation of phantom-based and log file patient-specific QA with complexity scores for VMAT

The motivation for this study was to reduce physics workload relating to patient- specific quality assurance (QA). VMAT plan delivery accuracy was determined from analysis of pre- and on-treatment trajectory log files and phantom-based ionization chamber array measurements. The correlation in this combination of measurements for patient-specific QA was investigated. The relationship between delivery errors and plan complexity was investigated as a potential method to further reduce patient-specific QA workload. Thirty VMAT plans from three treatment sites - prostate only, prostate and pelvic node (PPN), and head and neck (H&amp;N) - were retrospectively analyzed in this work. The 2D fluence delivery reconstructed from pretreatment and on-treatment trajectory log files was compared with the planned fluence using gamma analysis. Pretreatment dose delivery verification was also car- ried out using gamma analysis of ionization chamber array measurements compared with calculated doses. Pearson correlations were used to explore any relationship between trajectory log file (pretreatment and on-treatment) and ionization chamber array gamma results (pretreatment). Plan complexity was assessed using the MU/ arc and the modulation complexity score (MCS), with Pearson correlations used to examine any relationships between complexity metrics and plan delivery accu- racy. Trajectory log files were also used to further explore the accuracy of MLC and gantry positions. Pretreatment 1%/1 mm gamma passing rates for trajectory log file analysis were 99.1% (98.7%-99.2%), 99.3% (99.1%-99.5%), and 98.4% (97.3%-98.8%) (median (IQR)) for prostate, PPN, and H&amp;N, respectively, and were significantly correlated to on-treatment trajectory log file gamma results (R = 0.989, p &lt; 0.001). Pretreatment ionization chamber array (2%/2 mm) gamma results were also significantly correlated with on-treatment trajectory log file gamma results (R = 0.623, p &lt; 0.001). Furthermore, all gamma results displayed a significant correlation with MCS (R &gt; 0.57, p &lt; 0.001), but not with MU/arc. Average MLC position and gantry angle errors were 0.001 ± 0.002 mm and 0.025° ± 0.008° over all treatment sites and were not found to affect delivery accuracy. However, vari- ability in MLC speed was found to be directly related to MLC position accuracy. The accuracy of VMAT plan delivery assessed using pretreatment trajectory log file fluence delivery and ionization chamber array measurements were strongly correlated with on-treatment trajectory log file fluence delivery. The strong corre- lation between trajectory log file and phantom-based gamma results demonstrates potential to reduce our current patient-specific QA. Additionally, insight into MLC and gantry position accuracy through trajectory log file analysis and the strong cor- relation between gamma analysis results and the MCS could also provide further methodologies to both optimize the VMAT planning and QA process. 

"No Artist has Ethical Sympathies": Oscar Wilde, Aesthetics, and Moral Evolution

“There is no mode of action, no form of emotion, that we do not share with the lower animals” (137). This evolutionary claim is not attributable to Darwin, but to Oscar Wilde, who allows Gilbert to voice this bold assertion in “The True Function of Criticism.” While critics have long wrestled with the ethical stance and coherence of Wilde's writings, they have overlooked a significant influence on his work: debates concerning the evolution of morality that animated the periodicals in which he was writing. Wilde was fascinated by the proposition that complex human behaviours, including moral and aesthetic responses, might be traced back to evolutionary impulses. Significantly, he also wrote for a readership already engaged with these controversies.

OperationCheckpoint: SDN Application Control

One of the core properties of Software Defined Networking (SDN) is the ability for third parties to develop network applications. This introduces increased potential for innovation in networking from performance-enhanced to energy-efficient designs. In SDN, the application connects with the network via the SDN controller. A specific concern relating to this communication channel is whether an application can be trusted or not. For example, what information about the network state is gathered by the application? Is this information necessary for the application to execute or is it gathered for malicious intent? In this paper we present an approach to secure the northbound interface by introducing a permissions system that ensures that controller operations are available to trusted applications only. Implementation of this permissions system with our Operation Checkpoint adds negligible overhead and illustrates successful defense against unauthorized control function access attempts.

A Survey of Security in Software Defined Networks

The proposition of increased innovation in network applications and reduced cost for network operators has won over the networking world to the vision of Software-Defined Networking (SDN). With the excitement of holistic visibility across the network and the ability to program network devices, developers have rushed to present a range of new SDN-compliant hardware, software and services. However, amidst this frenzy of activity, one key element has only recently entered the debate: Network Security. In this article, security in SDN is surveyed presenting both the research community and industry advances in this area. The challenges to securing the network from the persistent attacker are discussed and the holistic approach to the security architecture that is required for SDN is described. Future research directions that will be key to providing network security in SDN are identified.

A feasibility study of auricular therapy and self-administered acupressure for insomnia following cancer treatment

Introduction: Many cancer patients experience sleeping difficulties which can persist several years after the completion of cancer treatment. Previous research suggests that acupuncture, and variants of acupuncture (acupressure, auricular therapy) may be effective treatment options for sleep disturbance. However, current evidence is limited for cancer patients.

Methods: Feasibility study with 3 arms. Seven cancer patients with insomnia randomised to receive either auricular therapy (attaching semen vaccariae seeds to ear acupoints) (n=4), self-acupressure (n=1) or no treatment (n=2). Participants assigned to receive auricular therapy or self-acupressure stimulated the acupoints each night an hour before retiring to bed. The duration of participant involvement was 5 weeks. Subjective sleep quality was measured at baseline and post-treatment using the Pittsburgh Sleep Quality Index (PSQI). The impact of treatment on concerns of importance to the participants themselves was measured using the Measure Yourself Concerns and Wellbeing (MYCaW). Each participant also completed a treatment log book.

Results: All participants completed their treatment. All auricular therapy and self-acupressure participants recorded clinically significant improvements in global PSQI scores. In the auricular therapy arm mean global PSQI reduced from 12.5 at baseline to 8 following completion of treatment. In the self-acupressure arm PSQI reduced from 15 to 11. While in the no treatment arm the mean PSQI score was 14.5 at both baseline and follow up.

Conclusions: Despite the limited sample size, both auricular therapy and self-acupressure may represent potentially effective treatments for cancer patients with insomnia. The positive findings suggest further research is warranted into both treatment modalities.