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Stretchable and high-performance supercapacitors with crumpled graphene papers.
No full textFabrication of unconventional energy storage devices with high stretchability and performance is challenging, but critical to practical operations of fully power-independent stretchable electronics. While supercapacitors represent a promising candidate for unconventional energy-storage devices, existing stretchable supercapacitors are limited by their low stretchability, complicated fabrication process, and high cost. Here, we report a simple and low-cost method to fabricate extremely stretchable and high-performance electrodes for supercapacitors based on new crumpled-graphene papers. Electrolyte-mediated-graphene paper bonded on a compliant substrate can be crumpled into self-organized patterns by harnessing mechanical instabilities in the graphene paper. As the substrate is stretched, the crumpled patterns unfold, maintaining high reliability of the graphene paper under multiple cycles of large deformation. Supercapacitor electrodes based on the crumpled graphene papers exhibit a unique combination of high stretchability (e.g., linear strain ~300%, areal strain ~800%), high electrochemical performance (e.g., specific capacitance ~196 F g(-1)), and high reliability (e.g., over 1000 stretch/relax cycles). An all-solid-state supercapacitor capable of large deformation is further fabricated to demonstrate practical applications of the crumpled-graphene-paper electrodes. Our method and design open a wide range of opportunities for manufacturing future energy-storage devices with desired deformability together with high performance
Embodied Fate: The Character Economy and the Neoliberal Subjectivity in Gacha Games
No full textGacha game is a new type of video game that gained popularity in the 2010s and the 20s. In popular gacha games such as Genshin Impact, Fate/Grand Order, and Blue Archive, like a video game version of lottery, players pay virtual or real currencies to obtain random valuable items or playable characters. In Embodied Fate, the author conducts a symptomatic reading of the gacha game: to analyze the desire structure of gacha gaming from the perspectives of media studies, ludology, psychoanalysis, and cultural studies. Numerous theoretical frameworks and critical categories are used for the analysis, including database consumption, character merchandising, psychoanalysis, avatar theory and action theory of ludology, neoliberalism, and precarity. By contextualizing gacha games in the anime media mix, it is shown that the production and consumption of virtual characters are the foundation of gacha games’ desire structure. Also, the author purposes that over-possession, the sophisticated dynamics between the player and the character, boost the desire for repetitive gacha gaming. Last, the author puts gacha games in the wider context of late capitalism and shows that neoliberalism creates gacha games and gacha players develop parasociality with characters to resist the insecurity of their precarious lived experience.</p
Personalized nutrition therapy in critical care: 10 expert recommendations.
No full textPersonalization of ICU nutrition is essential to future of critical care. Recommendations from American/European guidelines and practice suggestions incorporating recent literature are presented. Low-dose enteral nutrition (EN) or parenteral nutrition (PN) can be started within 48 h of admission. While EN is preferred route of delivery, new data highlight PN can be given safely without increased risk; thus, when early EN is not feasible, provision of isocaloric PN is effective and results in similar outcomes. Indirect calorimetry (IC) measurement of energy expenditure (EE) is recommended by both European/American guidelines after stabilization post-ICU admission. Below-measured EE (~ 70%) targets should be used during early phase and increased to match EE later in stay. Low-dose protein delivery can be used early (~ D1-2) (< 0.8 g/kg/d) and progressed to ≥ 1.2 g/kg/d as patients stabilize, with consideration of avoiding higher protein in unstable patients and in acute kidney injury not on CRRT. Intermittent-feeding schedules hold promise for further research. Clinicians must be aware of delivered energy/protein and what percentage of targets delivered nutrition represents. Computerized nutrition monitoring systems/platforms have become widely available. In patients at risk of micronutrient/vitamin losses (i.e., CRRT), evaluation of micronutrient levels should be considered post-ICU days 5-7 with repletion of deficiencies where indicated. In future, we hope use of muscle monitors such as ultrasound, CT scan, and/or BIA will be utilized to assess nutrition risk and monitor response to nutrition. Use of specialized anabolic nutrients such as HMB, creatine, and leucine to improve strength/muscle mass is promising in other populations and deserves future study. In post-ICU setting, continued use of IC measurement and other muscle measures should be considered to guide nutrition. Research on using rehabilitation interventions such as cardiopulmonary exercise testing (CPET) to guide post-ICU exercise/rehabilitation prescription and using anabolic agents such as testosterone/oxandrolone to promote post-ICU recovery is needed
Task Affinity and Its Applications in Machine Learning
No full textTransfer learning has been an essential aspect of machine learning, in which the knowledge from previously trained tasks is utilized to learn the incoming tasks. Recent works on transfer learning primarily focus on learning algorithms for the scenario of a learned source task and a target task. Here, the goal is to identify the source model's functional layers and corresponding parameters to fine-tune with the target task's dataset. It is established in the literature that similar tasks can share equivalent learning models (e.g., architecture, number of layers, parameters.) As a result, selecting relevant data samples and the trained models for the target task is also essential to the success of transfer learning. However, this area of research has yet to be thoroughly studied. This work focuses on task affinity, which is a similarity measure between tasks, and its applications in machine learning through a transfer learning process. Based on the Fisher Information matrices, the proposed task affinity is non-symmetric by definition due to the fact that it is easier to transfer the knowledge from a complex and comprehensive task to a simple task than vice versa. The task affinity helps determine the relevant source tasks, their corresponding datasets, and trained models for the target tasks. Additionally, a meta-learning framework, whose goal is learning to learn, is introduced based on the proposed task affinity. This framework is designed for a scenario with multiple learned source tasks and a target task. Here, the artificial intelligent agent is assumed to have sufficiently extensive memory for storing learned tasks (e.g., trained models and datasets). The meta-learning framework allows this agent to identify relevant knowledge from the source tasks and quickly learn the target task without human domain knowledge. This framework is motivated by the learning process of humans, which starts by learning simple and basic tasks before tackling more advanced subjects. For instance, when solving complicated tasks, humans often relate them to more straightforward tasks. This framework also helps reduce the amount of required data samples from the target task and further boosts the model's performance. Overall, this dissertation presents the definitions of task affinity and the meta-learning frameworks for various applications in machine learning, such as neural architecture search, few-shot learning, image generation, and causal inference. The theoretical and empirical studies indicate the consistency of the task affinity and the efficacy of the proposed framework compared with other state-of-the-art approaches to machine learning applications.</p
Arrhythmias Requiring ECMO in Infants Without Structural Congenital Heart Disease.
No full textArrhythmias account for 55 per 100,000 patient evaluations in pediatric emergency departments. Most arrhythmias in children are amenable to medical management or cardioversion. Rarely, arrhythmias lead to significant hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO) support. This study seeks to evaluate children under 1 year of age with a structurally normal heart requiring ECMO for an arrhythmia. This is a retrospective review of the Extracorporeal Life Support Organization Registry. All patients less than 1 year of age between 2009 and 2019 with a diagnosis of arrhythmia and without a diagnosis of structural heart malformation were included. Demographics, clinical characteristics, and outcomes were assessed with descriptive statistics and univariate and multivariable analyses. A total of 140 eligible patients were identified from the dataset. The most common arrhythmia was supraventricular tachycardia (SVT) in 70 (50%) patients. ECMO complications occurred in 106 (76.3%) patients and survival to discharge was achieved in 120 (85.7%) patients. In-hospital mortality was associated with neuromuscular blockade prior to ECMO [aOR 10.0 (95% CI 2.95-41.56), p < 0.001], neurologic ECMO complication [aOR 28.1 (95% CI 6.6-155.1), p < 0.001], and race with white race being protective [aOR 0.13, (95% CI 0.02-0.21), p = 0.002]. Similar survival and complication rates were found in subgroup analysis of SVT arrhythmias alone. Arrhythmias necessitating ECMO support in infants without structural congenital heart disease is a rare occurrence. However, survival to hospital discharge is favorable at greater than 85%. Given the favorable survival, earlier and more aggressive utilization of ECMO may result in improved outcomes
The Relationship Between Improvements in Myelopathy and Sagittal Realignment in Cervical Deformity Surgery Outcomes.
No full textStudy designRetrospective review.ObjectiveDetermine whether alignment or myelopathy improvement drives patient outcomes after cervical deformity (CD) corrective surgery.Summary of background dataCD correction involves radiographic malalignment correction and procedures to improve motor function and pain. It is unknown whether alignment or myelopathy improvement drives patient outcomes.MethodsInclusion: Patients with CD with baseline/1-year radiographic and outcome scores. Cervical alignment improvement was defined by improvement in Ames CD modifiers. modified Japanese Orthopaedic Association (mJOA) improvement was defined as mild [15-17], moderate [12-14], severe [ResultsA total of 70 patients (62 yr, 51% F) were included. Overall preoperative mJOA score was 13.04 ± 2.35. At baseline, 21 (30%) patients had mild myelopathy, 33 (47%) moderate, and 16 (23%) severe. Out of 70 patients 30 (44%) improved in mJOA and 13 (18.6%) met 1-year mJOA minimal clinically important difference. Distribution of improvement groups: 16/70 (23%) alignment-only improvement, 13 (19%) myelopathy-only improvement, 18 (26%) alignment and myelopathy improvement, and 23 (33%) no improvement. EQ-5D improved in 11 of 16 (69%) alignment-only patients, 11 of 18 (61%) myelopathy/alignment improvement, 13 of 13 (100%) myelopathy-only, and 10 of 23 (44%) no myelopathy/alignment improvement. There were no differences in decompression, baseline alignment, mJOA, EQ-5D, or NDI between groups. Patients who improved only in myelopathy showed significant differences in baseline-1Y EQ-5D (baseline: 0.74, 1 yr:0.83, P ConclusionAfter CD-corrective surgery, improvements in myelopathy symptoms and functional score were associated with superior 1-year patient-reported outcomes. Although there were no relationships between cervical-specific sagittal parameters and patient outcomes, global parameters of C2-S1 SVA and C7-S1 SVA showed significant correlations with overall 1-year mJOA, EQ-5D, and NDI. These results highlight myelopathy improvement as a key driver of patient-reported outcomes, and confirm the importance of sagittal alignment in patients with CD.Level of evidence3
Light up the Carolinas: Increasing Energy Fund Utilization Rates among Duke Energy Customers
No full textThere are multiple federal energy relief funds that are offered to help alleviate the burden of electric and gas utility bills for low-income households. Duke Energy services 71% of the retail electric customers in North Carolina and 34% in South Carolina, yet its customers account for a disproportionately low percentage of the Low-Income Home Energy Assistance Program (LIHEAP) funds. Through fund utilization data analysis and interviews with state and county governments and non-profits, this study helped provide clarity into the barriers keeping Duke Energy’s customers from applying for, and receiving, energy relief funds. These barriers were comprehensively addressed in the three recommendations provided to Duke Energy: streamline online resources for application and outreach, leverage customer data to develop a customized outreach strategy, and expand partnerships with North Carolina counties’ Department of Social Services and South Carolina Community Action Agencies
Comparison of best versus worst clinical outcomes for adult spinal deformity surgery: a retrospective review of a prospectively collected, multicenter database with 2-year follow-up.
No full textObjectAlthough recent studies suggest that average clinical outcomes are improved following surgery for selected adult spinal deformity (ASD) patients, these outcomes span a broad range. Few studies have specifically addressed factors that may predict favorable clinical outcomes. The objective of this study was to compare patients with ASD with best versus worst clinical outcomes following surgical treatment to identify distinguishing factors that may prove useful for patient counseling and optimization of clinical outcomes.MethodsThis is a retrospective review of a prospectively collected, multicenter, database of consecutively enrolled patients with ASD who were treated operatively. Inclusion criteria were age > 18 years and ASD. For patients with a minimum of 2-year follow-up, those with best versus worst outcomes were compared separately based on Scoliosis Research Society-22 (SRS-22) and Oswestry Disability Index (ODI) scores. Only patients with a baseline SRS-22 ≤ 3.5 or ODI ≥ 30 were included to minimize ceiling/floor effects. Best and worst outcomes were defined for SRS-22 (≥ 4.5 and ≤ 2.5, respectively) and ODI (≤ 15 and ≥ 50, respectively).ResultsOf 257 patients who met the inclusion criteria, 227 (88%) had complete baseline and 2-year follow-up SRS-22 and ODI outcomes scores and radiographic imaging and were analyzed in the present study. Of these 227 patients, 187 had baseline SRS-22 scores ≤ 3.5, and 162 had baseline ODI scores ≥ 30. Forthe SRS-22, best and worst outcomes criteria were met at follow-up for 25 and 27 patients, respectively. For the ODI, best and worst outcomes criteria were met at follow-up for 43 and 51 patients, respectively. With respect to the SRS-22, compared with best outcome patients, those with worst outcomes had higher baseline SRS-22 scores (p 0.1).ConclusionsFew studies have specifically addressed factors that distinguish between the best versus worst clinical outcomes for ASD surgery. In this study, baseline and perioperative factors distinguishing between the best and worst outcomes for ASD surgery included several patient factors (baseline depression, BMI, comorbidities, and disability), as well as residual deformity (SVA), and occurrence of complications. These findings suggest factors that may warrant greater awareness among clinicians to achieve optimal surgical outcomes for patients with ASD
A Novel Weave Tether Technique for Proximal Junctional Kyphosis Prevention in 71 Adult Spinal Deformity Patients: A Preliminary Case Series Assessing Early Complications and Efficacy.
No full textBackgroundProximal junctional kyphosis (PJK) rates may be as high as 69.4% after adult spinal deformity (ASD) surgery. PJK is one of the greatest unsolved challenges in long-segment fusions for ASD and remains a common indication for costly and impactful revision surgery. Junctional tethers may help to reduce the occurrence of PJK by attenuating adjacent-segment stress.ObjectiveTo report our experience and assess early safety associated with a novel "weave-tether technique" (WTT) for PJK prophylaxis in a large series of patients.MethodsThis single-center retrospective study evaluated consecutive patients who underwent ASD surgery including WTT between 2017 and 2018. Patient demographics, operative details, standard radiographic measurements, and complications were analyzed.ResultsA total of 71 patients (mean age 66 ± 12 yr, 65% women) were identified. WTT included application to the upper-most instrumented vertebrae (UIV) + 1 and UIV + 2 in 38(53.5%) and 33(46.5%) patients, respectively. No complications directly attributed to WTT usage were identified. For patients with radiographic follow-up (96%; mean duration 14 ± 12 mo), PJK occurred in 15% (mean 1.8 ± 1.0 mo postoperatively). Proximal junctional angle increased an average 4° (10° to 14°, P = .004). Rates of symptomatic PJK and revision for PJK were 8.8% and 2.9%, respectively.ConclusionPreliminary results support the safety of the WTT for PJK prophylaxis. Approximately 15% of patients developed radiographic PJK, no complications were directly attributed to WTT usage, and the revision rate for PJK was low. These early results warrant future research to assess longer-term efficacy of the WTT for PJK prophylaxis in ASD surgery
Resistance training in humans and mechanical overload in rodents do not elevate muscle protein lactylation
No full textAlthough several reports have hypothesized that exercise may increase skeletal muscle protein lactylation, empirical evidence in humans is lacking. Thus, we adopted a multi-faceted approach to examine if acute and subchronic resistance training (RT) altered skeletal muscle protein lactylation levels. In mice, we also sought to examine if surgical ablation-induced plantaris hypertrophy coincided with increases in muscle protein lactylation. To examine acute responses, participants’ blood lactate concentrations were assessed before, during, and after eight sets of an exhaustive lower body RT bout (n = 10 trained college-aged men). Vastus lateralis biopsies were also taken before, 3-h post, and 6-h post-exercise to assess muscle protein lactylation. To identify training responses, another cohort of trained college-aged men (n = 14) partook in 6 weeks of lower-body RT (3x/week) and biopsies were obtained before and following the intervention. Five-month-old C57BL/6 mice were subjected to 10 days of plantaris overload (OV, n = 8) or served as age-matched sham surgery controls (Sham, n = 8). Although acute resistance training significantly increased blood lactate responses ∼7.2-fold (p < 0.001), cytoplasmic and nuclear protein lactylation levels were not significantly altered at the post-exercise time points, and no putative lactylation-dependent mRNA was altered following exercise. Six weeks of RT did not alter cytoplasmic protein lactylation (p = 0.800) despite significantly increasing VL muscle size (+3.5%, p = 0.037), and again, no putative lactylation-dependent mRNA was significantly affected by training. Plantaris muscles were larger in OV versus Sham mice (+43.7%, p < 0.001). However, cytoplasmic protein lactylation was similar between groups (p = 0.369), and nuclear protein lactylation was significantly lower in OV versus Sham mice (p < 0.001). The current null findings, along with other recent null findings in the literature, challenge the thesis that lactate has an appreciable role in promoting skeletal muscle hypertrophy