Long-term Feasibility Research Articles

Parasitic electrodeposition in Zn-MnO2 batteries and its suppression for prolonged cyclability

The utilization of mildly acidic electrolyte and corresponding Mn salt pairing unlocked a path toward highly rechargeable Zn-MnO2 batteries, but long-term feasibility of these cathode-preserving strategy under practical conditions is never verified. In this study, in-situ MnO2 electrodeposition occurring in the battery recharging process is discovered to be a side reaction that substantially nullifies the practicality of the strategy. Particularly, it is identified to be responsible for irreversibly converting the electrolyte Mn ions to electrochemically passive species and triggering battery performance deterioration. These newfound recognitions lead to the formulation of a kinetic inhibition strategy, which is executed through an unconventional cathode electrode design. Specifically, graphite nanosheets with limited surface defects are incorporated into MnO2 electrodes to hinder the rate determining Mn adsorption process and thus effectively suppress the electrodeposition reaction. The resulting thin film binder-free MnO2 electrodes achieve near-full one-electron capacity reversibly for over 600 cycles, with an average columbic efficiency of ~99.8%. Overall, this study reveals the importance of suppressing MnO2 electrodeposition in Zn-MnO2 batteries and provides a contrasting view on key factors that dictate the stability of the system.

Extrahepatic bile duct reconstruction in pigs with heterogenous animal-derived artificial bile ducts: A preliminary experience.

BACKGROUNDExtrahepatic biliary duct injury (BDI) remains a complicated issue for surgeons. Although several approaches have been explored to address this problem, the high incidence of complications affects postoperative recovery. As a nonimmunogenic scaffold, an animal-derived artificial bile duct (ada-BD) could replace the defect, providing good physiological conditions for the regeneration of autologous bile duct structures without changing the original anatomical and physiologic conditions.AIMTo evaluate the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI in pigs.METHODSEight pigs were randomly divided into two groups in the study. The animal injury model was developed with an approximately 2 cm segmental defect of various parts of the common bile duct (CBD) for all pigs. A 2 cm long novel heterogenous animal-derived bile duct was used to repair this segmental defect (group A, ada-BD-to-duodenum anastomosis to repair the distal CBD defect; group B, ada-BD-to-CBD anastomosis to repair the intermedial CBD defect). The endpoint for observation was 6 mo (group A) and 12 mo (group B) after the operation. Liver function was regularly tested. Animals were euthanized at the above endpoints. Histological analysis was carried out to assess the efficacy of the repair.RESULTSThe median operative time was 2.45 h (2-3 h), with a median anastomosis time of 60.5 min (55-73 min). All experimental animals survived until the endpoints for observation. The liver function was almost regular. Histologic analysis indicated a marked biliary epithelial layer covering the neo-bile duct and regeneration of the submucosal connective tissue and smooth muscle without significant signs of immune rejection. In comparison, the submucosal connective tissue was more regular and thicker in group B than in group A, and there was superior integrity of the regeneration of the biliary epithelial layer. Despite the advantages of the regeneration of the bile duct smooth muscle observed in group A, the effect on the patency of the ada-BD grafts in group B was not confirmed by macroscopic assessment and cholangiography.CONCLUSIONThis approach appears to be feasible for repairing a CBD defect with an ada-BD. A large sample study is needed to confirm the durability and safety of these preliminary results.

INNV-22. PROSPECTIVE ANALYSIS OF UTILIZATION OF TELEMEDICINE IN NEURO-ONCOLOGY

Abstract OBJECTIVE to offer neuro-oncology care to patients in rural/suburban settings that may not otherwise have access to urban amenities, specialists, and clinical trials. To test the feasibility of telemedicine in Neuro-Oncology by measuring cost savings, travel time savings, and burden of care. To screen patients for clinical trials. BACKGROUND Neuro-Oncology services are primarily available only at tertiary care hospitals. This increases the burden of care for patients who live in suburban and rural areas, as they have to travel long distances for their care. Hence, some families and patients do not seek care as travel time increases the stress on patients and their caretakers who are already dealing with the devastating diagnosis of a brain tumor. Similarly, these patient groups do not have access to clinical trials. METHODS To help ease above hardships on patients, we built a telemedicine Neuro-Oncology program that is studying the quality of care compared with daily routine visits in the cancer center. We are enrolling 30 patients in each cohort of the study, cohort A, telemedicine visits and cohort B, regular clinic visits for a total of 60 patients after obtaining written consent. We are providing them survey identifying quality measures of care (24 questions). The survey is provided to the patients and their caregivers at the end of their visit. RESULTS Survey answers are inputted into Survey Monkey. After the completion of 60 total patient visits, surveys will be evaluated and the results will be analyzed. CONCLUSION We are looking for the long-term feasibility of utilizing telemedicine care in rural/suburban settings for Neuro-Oncology patients. We anticipate that there will be cost savings, travel time savings and reduction in burden of care without compromising patient satisfaction or quality of care provided. We are also studying the feasibility of screening patients for clinical trials.

Ex-vivo mechanical sealing properties and toxicity of a bioadhesive patch as sealing system for fetal membrane iatrogenic defects

Preterm prelabor rupture of membranes (PPROM) is the most frequent complication of fetal surgery. Strategies to seal the membrane defect created by fetoscopy aiming to reduce the occurrence of PPROM have been attempted with little success. The objective of this study was to evaluate the ex-vivo mechanical sealing properties and toxicity of four different bioadhesives integrated in semi-rigid patches for fetal membranes. We performed and ex-vivo study using term human fetal membranes to compare the four integrated patches composed of silicone or silicone-polyurethane combined with dopaminated-hyaluronic acid or hydroxypropyl methylcellulose (HPMC). For mechanical sealing properties, membranes were mounted in a multiaxial inflation device with saline, perforated and sealed with the 4 combinations. We measured bursting pressure and maximum pressure free of leakage (n = 8). For toxicity, an organ culture of membranes sealed with the patches was used to measure pyknotic index (PI) and lactate dehydrogenase (LDH) concentration (n = 5). All bioadhesives achieved appropriate bursting pressures, but only HPMC forms achieved high maximum pressures free of leakage. Concerning toxicity, bioadhesives showed low PI and LDH levels, suggesting no cell toxicity. We conclude that a semi-rigid patch coated with HPMC achieved ex-vivo sealing of iatrogenic defects in fetal membranes with no signs of cell toxicity. These results warrant further research addressing long-term adhesiveness and feasibility as a sealing system for fetoscopy.

Results of Surgical Repair of Hilar Renal Artery Aneurysm to Preserve Renal Blood Flow.

Objective: Surgical indications and procedures for hilar renal artery aneurysm (HRAA) are controversial in terms of invasiveness and feasibility. Catheter treatment is minimally invasive but leads to renal dysfunction due to renal infarction. This study aims to investigate the results of surgical repair of HRAA.Method: Fourteen patients (58.7±11.6 years old, 7 male) who underwent surgical repair of HRAA were retrospectively reviewed. Nine patients (64%) developed HRAA in the right renal artery, and the mean maximum aneurysmal diameter was 25.9±10.3 mm. HRAA was exposed via the extraperitoneal approach. HRAA was resected completely, and reconstruction of renal arteries was performed by direct closure in two, direct anastomosis in nine, and interposition of saphenous vein graft in three patients.Results: The average operation and renal ischemic times were 186±49 and 35±16 min, respectively. No operative death occurred, and postoperative renal function at the time of discharge had not deteriorated (creatinine, 0.74±0.15 mg/dl). During the follow-up periods (4.7±5.1 years), there was no death, no new introduction of hemodialysis, and no recurrence of renal artery aneurysm.Conclusion: Surgical repair of HRAA remains a valid option because of its operative safety, preservation of renal function, and long-term feasibility and patency.

Smart energy technologies

The development of information technologies allowed digitalization in different fields, as in, for instance, the engineering field, which is one of the most challenging fields, since smart supported solutions can bring important benefits to society in general. The energy sector is already experiencing gradual digitalization with important advances to be made in the upcoming next decades. Moreover, the role of smart energy technologies is a significant one in the ongoing energy transitions, since it can ensure various technological upgrades, especially in the case of hybrid energy systems or in different energy generation technologies in general. Efficiency improvement of energy technologies, processes, as well as specific system components is possible through the implementation of smart technologies. Additionally, environmental footprints of different energy technologies could also be reduced by the implementation of smart and Internet of Things (IoT) supported devices or products. However, the development of smart energy technologies needs to be provided in a controlled manner to reach sustainable criteria. Namely, the rapid rise in various smart technologies is potentially causing fast consumption of limited raw resources needed for assembly of electronic equipment; on the other hand, we are potentially being faced with the increased generation of electronic waste and release of other pollutants. Development of smart technologies should be carefully monitored to ensure long-term feasibility and environmental suitability. Finally, the progress of smart energy technologies strongly depends on further advances in the development of electronic components, software solutions, sensor technologies, and general network infrastructure. Smart energy technologies are for certain an opportunity for humanity, which brings important and useful benefits. This special issue is related to selected papers from the 4th International Conference on Smart and Sustainable Technologies (SpliTech2019), which was held in Split and Bol (Island of Brač), Croatia, in June 2019. The SpliTech2019 event linked various engineering professions and provided a platform for a vibrant and sounding discussion between researchers and professionals from the industry. The conference hosted over 200 delegates from 35 countries worldwide. The focus of the conference was directed to the role of smart technologies in the technological development of societies as well as the impact of the smart technologies on the use of resources. Over 200 presentations were delivered and related to the fundamental and applied research from interdisciplinary research topics. Tutorials, workshops, as well as round-table discussions were organized to promote research-based solutions with industrial applications. A traditional, “Meet the Editor” workshop was organized and hosted distinguished editors from reputable peer-review journals to support young and less experienced authors. Finally, I would like to express my appreciation to the keynote and invited speakers, to the technical program committee members, session chairs, reviewers, and to the valuable authors for their general contribution. Special thanks to the SpliTech2019 organization team, who made this event possible and to the conference sponsors for their continuous support. Special thanks to Prof. Dr. Ibrahim Dincer for his overall support and efforts during the initial preparation as well as for the realization of this special issue. Prof. Dr. Sandro Nižetić would also like to acknowledge the support of the Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture together with the University of Split and to the IEEE Communications Society.

IV/IT hUC-MSCs Infusion in RRMS and NMO: A 10-Year Follow-Up Study.

Background: Stem cell transplantation is emerging as a potential therapeutic strategy in several autoimmune diseases. However, the safety and feasibility of long-term combined intravenous (IV) and intrathecal (IT) administration of hUC-MSCs in relapse remitting multiple sclerosis (RRMS) and neuromyelitis optica (NMO) is largely unknown.Objectives: In this study, we followed up the long-term safety and feasibility of combined IV and IT human umbilical cord mesenchymal stem cells (hUC-MSCs) transplantation in patients with RRMS and NMO.Methods: Five NMO patients and 5 RRMS patients were treated intravenously (4 times) and intrathecally (3 times) over a 21-day period with low-dose allogeneic umbilical cord blood–derived MSCs. All of the patients were monitored regularly by an investigator in a blinded manner to access the Expanded Disability Status Scale, MRI characteristics, and adverse events every 3 months within 12 months and once every year thereafter for 10 years after transplantation.Results: During the long-term follow-up, our data suggested that combined IV and IT administration of hUC-MSCs transplantation is safe and feasible. None of the intolerant adverse events, such as tumor formation and peripheral organ/tissue disorders, were observed throughout the 10-year follow-up.Conclusions: These data suggest that combined intravenous and intrathecal low-dose hUC-MSCs transplantation is safe and feasible in RRMS and NMO patients in the long term. The conclusion requires confirmation by future clinical trials in a larger cohort.

Periprocedural and long-term safety and feasibility of direct oral anticoagulants in patients with biological valve undergoing radiofrequency catheter ablation for atrial fibrillation: a prospective multicenter study.

Direct oral anticoagulants (DOACs) are contraindicated in patients with atrial fibrillation (AF) and mechanical cardiac valves. However, safety and efficacy are controversial in patients with biological cardiac valves. We report the safety and feasibility of periprocedural and long-term treatment with DOACs in patients with biological valves undergoing ablation for AF. A total of 127 patients with AF and biological cardiac valve undergoing CA on uninterrupted DOAC were matched by gender and age with 127 patients with AF and biological cardiac valves undergoing CA on uninterrupted warfarin. All patients were anticoagulated for at least 3-4weeks prior to ablation with either rivaroxaban (70%) or apixaban (30%), which were continued for at least 3months and subsequently based on CHA2DS2-VASc score. Mean age of the study population was 63.0 ± 10.9 with 66% being male. The majority of patients on NOACs had aortic valve replacement (59%), while mitral valve was replaced in 41% of patients, which did not differ from the matched cohort on coumadin (aortic valve 57% and mitral valve 43%, (p = 0.8) (p = 0.8), respectively). The CHADS2 score was ≥ 2 in 90 patients (71.0%) on DOAC and 86 patients in (68%) the control (p = 0.6) group. Patients underwent ablation predominantly with uninterrupted rivaroxaban [89 (70%)], while the remaining 38 patients (30%) underwent ablation while on apixaban. Two groin hematomas were observed periprocedurally in both groups. No stroke/transient ischemic attack (TIA) was observed both periprocedurally and at long-term follow-up in either group. Periprocedural and long-term administration of DOACs in patients with biological cardiac valves undergoing AF ablation appears as safe as warfarin therapy.

Short-term and Long-term Feasibility, Safety, and Efficacy of High-Intensity Interval Training in Cardiac Rehabilitation

High-intensity interval training (HIIT) is recognized as a potent stimulus for improving cardiorespiratory fitness (volume of oxygen consumption [VO2] peak) in patients with coronary artery disease (CAD). However, the feasibility, safety, and long-term effects of HIIT in this population are unclear. To compare HIIT with moderate-intensity continuous training (MICT) for feasibility, safety, adherence, and efficacy of improving VO2 peak in patients with CAD. In this single-center randomized clinical trial, participants underwent 4 weeks of supervised training in a private hospital cardiac rehabilitation program, with subsequent home-based training and follow-up over 12 months. A total of 96 participants with angiographically proven CAD aged 18 to 80 years were enrolled, and 93 participants were medically cleared for participation following a cardiopulmonary exercise test. Data were collected from May 2016 to December 2018, and data were analyzed from December 2018 to August 2019. A 4 × 4-minute HIIT program or a 40-minute MICT program (usual care). Patients completed 3 sessions per week (2 supervised and 1 home-based session) for 4 weeks and 3 home-based sessions per week thereafter for 48 weeks. The primary outcome was change in VO2 peak during the cardiopulmonary exercise test from baseline to 4 weeks. Further testing occurred at 3, 6, and 12 months. Secondary outcomes were feasibility, safety, adherence, cardiovascular risk factors, and quality of life. Of 93 randomized participants, 78 (84%) were male, the mean (SD) age was 65 (8) years, and 46 were randomized to HIIT and 47 to MICT. A total of 86 participants completed testing at 4 weeks for the primary outcome, including 43 in the HIIT group and 43 in the MICT group; 69 completed testing at 12 months for VO2 peak, including 32 in the HIIT group and 37 in the MICT group. After 4 weeks, HIIT improved VO2 peak by 10% compared with 4% in the MICT group (mean [SD] oxygen uptake: HIIT, 2.9 [3.4] mL/kg/min; MICT, 1.2 [3.4] mL/kg/min; P = .02). After 12 months, there were similar improvements from baseline between groups, with a 10% improvement in the HIIT group and a 7% improvement in the MICT group (mean [SD] oxygen uptake: HIIT, 2.9 [4.5] mL/kg/min; MICT, 1.8 [4.3] mL/kg/min; P = .30). Both groups had high feasibility scores and low rates of withdrawal due to serious adverse events (3 participants in the HIIT group and 1 participant in the MICT group). One event occurred following exercise (hypotension) in the HIIT group. Over 12 months, both home-based HIIT and MICT had low rates of adherence (HIIT, 18 of 34 [53%]; MICT, 15 of 37 [41%]; P = .35) compared with the supervised stage (HIIT, 39 of 44 [91%]; MICT, 39 of 43 [91%]; P > .99). In this randomized clinical trial, a 4-week HIIT program improved VO2 peak compared with MICT in patients with CAD attending cardiac rehabilitation. However, improvements in VO2 peak at 12 months were similar for both groups. HIIT was feasible and safe, with similar adherence to MICT over 12-month follow-up. These findings support inclusion of HIIT in cardiac rehabilitation programs as an adjunct or alternative modality to moderate-intensity exercise. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12615001292561.

Long-term feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a pig model

BackgroundHigh flow bypass surgery can be a last resort procedure for patients suffering from complex neurovascular pathology. Temporary occlusion of a recipient artery in these patients could result in debilitating neurological deficits. We developed a sutureless, mechanical anastomotic connection device, the SELANA clip (Sutureless Excimer Laser-Assisted Non-occlusive Anastomosis clip: SEcl). In the present study, we aim to determine the long-term non-inferiority of the SEcl technique compared with historical data of the conventional ELANA anastomosis technique.MethodsA total of 18 SEcl bypasses were created on the carotid artery in a porcine model in 6 different survival groups. Mean application times, flap retrieval rates, hemostasis, patency, flow, endothelialization, and remodeling were assessed.ResultsThe mean application time of the SEcl anastomoses was 15.2 ± 9.6 min, which was faster compared with the conventional ELANA anastomoses. The flap retrieval rate of the SEcl anastomoses was 86% (32/37). Direct hemostasis was achieved in 89% (33/37) SEcl anastomoses. Patency in all surviving animals was 94% (17/18). Bypass flow after six months was 156.5 ± 24.7 mL/min. Full endothelialization of the SEcl pins was observed after 3 weeks.ConclusionThe SEcl technique is not inferior to the ELANA technique regarding patency, flap retrieval rate, flow, and endothelialization. On the basis of a significantly shorter application time and superior hemostasis, the SEcl technique could be preferable over the ELANA technique. A pilot study in patients is a logical next step based on our current results.

Hill farmers, habitats and time: the potential of historical ecology in upland management and conservation

ABSTRACT This article responds to calls for the historical sciences to inform adaptation in the Anthropocene, in this case, the sustainability of hill farming in view of EU habitat conservation. Focusing on Kerry, Ireland, it highlights the difficulties that conservation of upland bog, heath and grassland habitats faces due to rural depopulation. It then uses landscape history to assess the long-term feasibility of conserving/restoring these habitats according to EU directives, pointing to the remarkably recent disappearance of woodland due to grazing and deforestation. Instead of being ‘traditional’, as conservation discourse holds it to be, historical management of uplands by farmers could vary greatly depending on socio-political factors and economic trends. I discuss how this historical ecology of change helps to explain the failure of conservation in parts of Ireland, and outline how ‘lessons from the past’ may contribute to sustainable upland management if co-evolution is accepted as an on-going process.

Treating Home Versus Predialysis Blood Pressure Among In-Center Hemodialysis Patients: A Pilot Randomized Trial

Observational studies have reported a U-shaped association between blood pressure (BP) before a hemodialysis session and death. In contrast, because a linear association between out-of-dialysis-unit BP and death has been reported, home BP may be a better target for treatment. To test the feasibility of this approach, we conducted a pilot trial of treating home versus predialysis BP in hemodialysis patients. A 4-month, parallel, randomized, controlled trial. 50 prevalent hemodialysis patients in San Francisco and Seattle. Participants were randomly assigned using 1:1 block randomization, stratified by site. To target home systolic BP (SBP)of 100-<140 mm Hg versus predialysis SBP of 100-<140mm Hg. Home and predialysis SBPs were ascertainedevery 2 weeks. Dry weight and BP medications were adjusted to reach the target SBP. Primary outcomes were feasibility, adherence, safety. and tolerability. 50 of 70 (71%) patients who were approached agreed to participate. All enrollees completed the study except for 1 who received a kidney transplant. In the home BP treatment group, adherence to obtaining/reporting home BP was 97.4% (and consistent over the 4 months). There was no increased frequency of high (defined as SBP>200mm Hg; 0.2% vs 0%) or low (defined as<90mm Hg; 1.8% vs 1.2%) predialysis BP readings in the home versus predialysis treatment arms, respectively. However, participants in the home BP arm had higher frequency of fatigue (32% vs 16%). Small sample size. This pilot trial demonstrates feasibility and high adherence to home BP measurement and treatment in hemodialysis patients. Larger trials to test the long-term feasibility, efficacy, and safety of home BP treatment in hemodialysis patients should be conducted. National Institutes of Health, Satellite Healthcare, and Northwest Kidney Centers. Registered at ClinicalTrials.gov with study number NCT03459807.

Incumbent Success in the Era of Ferment: Navigation of Intergenerational Transition of Technology

How can some incumbent firms proactively navigate technological change while others fail to do so? We explore this question by studying the dynamics of incumbents’ engagement in an era of ferment, in which new technological options challenge the dominance of the current technology generation. We take a real option theory and focus on a successful incumbent firm, ASML, in a period when varieties of new technological options were threatening the dominance of the optical-lithography regime. Our findings show that ASML managed this turbulent period in such a way that it gained the core position in both existing and new technological regimes. First, ASML organized an agile, highly authorized core research team to explore new technological options within and outside of ASML. Second, as the experimental development of technological options progressed, ASML persistently relied on the scientific rules of physics and economics in the assessment of the long-term feasibility and extendibility of technological options, rather than on their current performance. Finally, the timely management of commitment and abandonment of technological options in its portfolio enabled ASML to play an active role in the dynamics of transition to the next generation of lithography technology.

Long-term safety and tolerability of subretinal transplantation of embryonic stem cell-derived retinal pigment epithelium in Asian Stargardt disease patients

BackgroundAlthough human embryonic stem cells (hESCs) have been considered a potential therapeutic option for regenerative medicine, there are some concerns regarding tumorigenicity, immunogenicity and ethical considerations. Stargardt macular dystrophy (SMD)...

The Damaged Spinal Cord Is a Suitable Target for Stem Cell Transplantation

Background. Given individuals with spinal cord injury (SCI) approaching 2 million, viable options for regenerative repair are desperately needed. Human central nervous system stem cells (HuCNS-SC) are self-renewing, multipotent adult stem cells that engraft, migrate, and differentiate in appropriate regions in multiple animal models of injured brain and spinal cord. Preclinical improved SCI locomotor function provided rationale for the first-in-human SCI clinical trial of HuCNS-SC cells. Evidence of feasibility and long-term safety of cell transplantation into damaged human cord is needed to foster translational progression of cellular therapies. Methods. A first-ever, multisite phase I/IIa trial involving surgical transplantation of 20 million HuCNS-SC cells into the thoracic cord in 12 AIS A or B subjects (traumatic, T2-T11 motor-complete, sensory-incomplete), aged 19 to 53 years, demonstrated safety and preliminary efficacy. Six-year follow-up data were collected (sensory thresholds and neuroimaging augmenting clinical assessments). Findings. The study revealed short- and long-term surgical and medical safety (well-tolerated immunosuppression in population susceptible to infections). Preliminary efficacy measures identified 5/12 with reliable sensory improvements. Unfortunately, without thoracic muscles available for manual muscle examination, thoracic motor changes could not be measured. Lower limb motor scores did not change during the study. Cervical cord imaging revealed, no tumor formation or malformation of the lesion area, and secondary supralesional structural changes similar to SCI control subjects. Interpretation. Short- and long-term safety and feasibility support the consideration of cell transplantation for patients with complete and incomplete SCI. This report is an important step to prepare, foster, and maintain the therapeutic development of cell transplantation for human SCI.

Multivisceral Resection for Locally Advanced Gastric Cancer

BackgroundLocally advanced gastric cancer (LAGC) presents a therapeutic dilemma, particularly as it often involves adjacent organs through desmoplasia or true pathologic invasion. To obtain a margin-negative resection, these tumors require en bloc gastrectomy with multivisceral resection (G+MVR), and contention remains regarding its safety and oncologic benefit. MethodsWe used the National Cancer Database to retrospectively evaluate the short- and long-term outcomes of patients with LAGC treated in the USA between 2004 and 2016. Associations with margin status and perioperative outcomes were calculated using logistic regression. Survival was estimated using Cox proportional hazards regression and the Kaplan-Meier method. ResultsOverall, 785 pathologic stage T4b (pT4b) patients diagnosed with LAGC underwent gastrectomy (n = 438) or G+MVR (n = 347). There was no association between G+MVR and short- or long-term mortality. Positive resection margins (HR 1.68, 95% CI 1.40–2.03), the presence of nodal disease (HRs 1.46–1.50), treatment at a high-volume center (HR 0.76, 95% CI 0.68–0.85), and the receipt of adjuvant chemotherapy (HR 0.64, 95% CI 0.51–0.80) were independently associated with overall survival. Diffuse-type histology was associated with higher rates of an R1 resection (OR 3.60, 95% CI 2.20–5.87). Perioperative and long-term survival metrics were comparable between patients with pT4a and pT4b LAGC who underwent a margin-negative G+MVR. Undergoing a margin-negative G+MVR imparted a 6-month survival benefit over non-curative gastrectomy alone (p < 0.001). ConclusionsOur study demonstrates the safety and long-term feasibility of G+MVR for disease clearance in well-selected patients with LAGC, and we advocate for their referral to high-volume centers for optimal care.

Assessing the costs and returns of on-farm food safety improvements: A survey of Good Agricultural Practices (GAPs) training participants.

Good Agricultural Practices (GAPs) training programs were developed to provide guidance to fruit and vegetable growers on how to reduce food safety risks on the farm. These programs have been enhanced over the years due, in part, to increasing buyer and regulatory requirements. However, the costs of implementing additional food safety practices has been identified as a primary barrier to long-term farm financial feasibility, particularly for smaller scale producers. A survey of past participants in New York State revealed that increasing food safety improvements facilitated by GAPs have not significantly impacted the size of farm operations or the types of crops grown. In terms of farm size, we show that both the financial costs and financial benefits of food safety improvements increase with farm size, but at decreasing rates. In so doing, relatively higher market sales gains per acre by smaller farms from additional food safety investments offset the relatively higher costs to them of their implementation. We also demonstrate that benefits of food safety improvements were significantly higher for farms that had third-party food safety audits and for those that market primarily through wholesale channels. The results should prove welcome by educators as they encourage participation by all scales of producers in GAPs trainings and for growers in understanding that food safety investments can support both reduced microbial risks and sales growth.

Feasibility of water-cooled photovoltaic panels under the efficiency and durability aspects

Photovoltaic (PV) panels can increase their efficiency and durability by using water-cooled systems. In this paper, the authors present a methodology to establish the degradation rate (DR) of PV panels related to their durability and efficiency under cooled versus no-cooled conditions. A long-term feasibility analysis of PV power plants with some suggested modifications are discussed in detail. A standard system was designed to cool down the PV modules. The simulations used with this purpose are based on several publications with relevant aspects carried out in the literature using Matlab-based modeling data. Such results were then confirmed by Homer program to predict the efficiency and durability of PV panels within a lifetime period of 25 years. To illustrate the methodology proposed here, the simulation parameters were used for the city of Santa Maria-RS, Brazil. The results allowed to conclude that cooling combined with heated water for domestic usage can decrease the PV degradation rate by 3% and provide an increased efficiency by almost 30% with respect to the PV panels without such cooling approaches. Therefore, the final results conclude that installation of water-cooled PV panels is an attractive and feasible option for a short- and long-term efficiency improvement with great impact on the expansion and durability of PV power plants.

The case for value chain resilience

Purpose Value chain analyses that help businesses build competitive advantage must include considerations of unpredictable shocks and stressors that can create costly business disruptions. Enriching value chain analysis with considerations of system resilience, meaning the ability to recover and adapt after adverse events, can reduce the imposed costs of such disruptions. Design/methodology/approach The paper provides a perspective on resilience as both an expansion and complement of risk analysis. It examines applications of both concepts within current value chain literature and within supply chain literature that may inform potential directions or pitfalls for future value chain investigations. Established frameworks from the broader field of resilience research are proposed for value chain resilience analysis and practice. Findings The synthesis reveals a need to expand value chain resilience analysis to incorporate phases of system disruption. Current explorations in the literature lack an explicit acknowledgement and understanding of system-level effects related to interconnectedness. The quantification methods proposed for value chain resilience analysis address these gaps. Originality/value Using broader resilience conceptualizations, this paper introduces the resilience matrix and three-tiered resilience assessment that can be applied within value chain analyses to better safeguard long-term business feasibility despite a context of increasing threats.

Whole-body Electromyostimulation plus Caloric Restriction in Metabolic Syndrome.

We investigated early effects of Whole-Body Electromyostimulation added to hypocaloric diet on metabolic syndrome features in sedentary middle-aged individuals. We randomly assigned 25 patients to Whole-Body Electromyostimulation plus caloric restriction or caloric restriction alone for 26 weeks. Anthropometrics, blood pressure, fasting glucose and insulin, HOMA-IR, glycated hemoglobin, lipids, uric acid, creatinphosphokynase, C-reactive protein were assessed. Body composition was evaluated with direct-segmental, multi-frequency Bioelectrical Impedance Analysis. Both groups lost approximately 10% of weight, with similar effects on waist circumference and fat mass. Change in free-fat mass was significantly different between groups (caloric restriction -1.5±0.2 vs. Whole-Body Electromyostimulation plus caloric restriction +1.1±0.4 kg, p=0.03). Whole-Body Electromyostimulation plus caloric restriction group experienced greater percent reductions in insulin (-45.5±4.4 vs. -28.2±3.6%, p=0.002), HOMA-IR (-51.3±3.2 vs. -25.1±1.8%, p=0.001), triglycerides (-22.5±2.9 vs. -4.1±1.6%, p=0.004) and triglycerides/HDL (p=0.028). Subjects trained with Whole-Body Electromyostimulation had also significant improvement in systolic pressure (138±4 vs. 126±7 mmHg, p=0.038). No discontinuations for adverse events occurred. In middle-aged sedentary subjects with the metabolic syndrome, Whole-Body Electromyostimulation with caloric restriction for 26 weeks can improve insulin-resistance and lipid profile compared to diet alone. Further studies are needed to ascertain long-term efficacy and feasibility of this approach in individuals with the metabolic syndrome.