Unique Location Research Articles

Vertex epidural hematoma: Diagnosis, therapeutic consideration and outcome

ObjectiveVertex epidural hematoma (VEDH) is a relatively uncommon type of intracranial hematoma. Because of its unique location and the potential of massive intraoperative bleeding, diagnosis and surgical intervention of VEDH may be challenging. Materials and methodsA retrospective analysis of 32 patients with VEDH was undertaken to investigate the prognostic factor and therapeutic strategy of VEDH. Special attention was paid to the relationship between fracture pattern, surgical method, intraoperative blood loss and outcome. ResultsPatients treated surgically had a higher percentage of consciousness disturbance and a significantly larger size of VEDH compared with patients treated conservatively (p = 0.029 and p < 0.0001, respectively). Bleeding from the injured superior sagittal sinus (SSS) was noted in six of nine patients (67%) with a linear fracture parallel to the SSS. Only one patient (20%) with a linear fracture crossing the SSS had bleeding from the injured SSS. Five of eight patients (63%) with sagittal suture diastasis experienced bleeding from the SSS. All patients with massive blood loss and six of seven patients developing intraoperative shock had copious bleeding from the injured SSS. All patients with intraoperative massive bleeding and shock underwent traditional “simple craniotomy”. No patients undergoing “strip craniotomy” experienced massive bleeding. Thrombocytopenia (p = 0.008), headache (p = 0.015), consciousness disturbance (p = 0.043), pupil reactivity (p = 0.010), GCS score (p < 0.0001) and the relationship between skull fracture and the SSS (p = 0.037) were significant prognostic factors. ConclusionOur study demonstrated GCS score may be a significant prognostic factor in patients with VEDH. Bleeding from the injured SSS occurred frequently in VEDH patients with a linear skull fracture parallel to the SSS or sagittal suture diastasis and could cause devastating hemorrhage. When operating on such patients, the surgical team should prepare for the possibility of massive blood loss and intraoperative shock. Bilateral parasagittal craniotomies with preservation of a central bone strip containing the sagittal suture (strip craniotomy) to allow application of tack-up sutures from the dura to the bone strip may be more suitable for VEDH evacuation.

Nepal’s Geo-Stretegic Significance, Challenges And Opportunities

Geo-strategic significance is an important factor for the development and prosperity of the country. Nepal’s geo-strategic location, crammed between India and China, has its challenges and opportunities. Due to its unique location, Nepal is getting heightened attention from great powers. The factor of having a strategic location doesn’t quite guarantee the nation’s sovereignty, prosperity and growth rather it needs conscious and constructive efforts. Being a buffer state, security situation in Nepal is always a major concern for both neighbors. Traditionally India had an important role in Nepal’s economic cooperation, trade, transit and investment. After Nepal’s transition to a republic state China’s support has seemly increased in Nepal with its investment in development projects, increased bilateral visits, bilateral mechanism and cultural cooperation. China’s increased role in Nepal can understood as competing other global power’s geo-strategic interests. Question arises, whether Nepal has geostrategic significance because of its location, which could be capitalized for growth of the nation and at the same time carefully; formulate its foreign policy while balancing its diplomacy to avoid precipitation of a spiral of counterbalancing intrusion? Nepal should carefully analyze these global powers and its emerging foreign policies and should devise its diplomatic exercise prioritizing Nepal’s national interests and keeping perfect balance among them.

Abstract 241: Comparison Of A Phone-based Business AED Survey Canvas, 911-Dispatch AED Inventory, And State-Mandated AED Registry In Forsyth County, NC

Introduction: In North Carolina (NC), 911-dispatch centers are accelerating treatment to OHCA by notifying bystanders of nearby public AEDs. This system depends on a comprehensive registry of AED locations. State law requires registration of AEDs with the NC Office of EMS (NC OEMS), but adherence to this legislation is unknown. The purpose of this study was to determine the registration status of public AEDs in a large county in NC. Methods: Using structured phone surveys, we determined the AED status and information for businesses in Forsyth County, NC. Using a national business database, we identified all registered large businesses (&gt;20 employees) and select small businesses (1-19 employees) most likely to have an AED: healthcare, government, childcare, educational, and religious organizations. In addition, AED lists were elicited from large organizations (e.g non-hospital health clinics, universities, and county government) (n=293 AEDs), NC OEMS (n=336), and 911-dispatch center (n=73). Results: Between 1/2/22-5/7/22, we contacted 1,702 businesses (response rate =79.1%). Of these, 411 (30.5%) businesses reported &gt;= 1 AEDs. Additionally, 106 unique AED locations were identified from large organizations; 22 from the 911-dispatch; and 34 from the NC OEMS registry. The final AED list contained 963 AEDs at 573 unique locations (Table). Identified AEDs were most frequently located at health clinics, schools, colleges, offices, industrial facilities, and churches. A majority of AEDs (65.1% [627/963]) were not previously registered in the NC OEMS AED registry. Few business AEDs (11.8% [114/963]) were listed in the county dispatch agency’s geolocation software system. Conclusion: Most businesses and organizations in our survey canvas had AEDs that were unregistered in a state-mandated AED registry. Structured strategies to increase reporting of publicly available AEDs to NC OEMS and transfer of that information to county 911-dispatch systems are needed.

Abstract 9555: Human Valve Atlas in Health and Disease

Background: Semilunar and atrioventricular valves have distinct structures and are often affected differently in congenital valve diseases (CVD). Here we aim to define and compare the cellular composition and transcriptomic signatures of four different human fetal valves, which provide a reference map to engineer valves in vitro , and to study valve-specific impairment in CVD. Methods: Aortic, pulmonary, mitral, and tricuspid valves were barcoded respectively from a healthy human fetal heart at gestational day 105. Single-cell (sc)RNA-seq was performed. Spatial localization of new subpopulations was determined by immunostaining and in situ hybridization. Cell-cell interaction was revealed by cell-chat. Results: scRNA-seq analysis revealed major cell types including endothelial (VECs), interstitial (VICs), and immune cells. In addition to reported collagen &amp; glycosaminoglycan (GAG) VIC in mice, VIC sub-clustering identified two human-specific APOE+ and CLDN11+ subpopulations. APOE+ VICs specifically located underneath VECs facing unidirectional flow, indicating cell-cell interaction of APOE+ VICs &amp; VECs. VEC sub-clustering identified lymphatic VECs under turbulent flow, while CD55+ &amp; PTGDS+ VECs under unidirectional flow. Cell-chat uncovered NOTCH3-JAG1 pairs in facilitating the co-development of spatially adjacent APOE+ VICs &amp; PTGDS+ VECs. To further uncover valve-specific signatures, we compared gene expression profiles of four valves. In lymphatic VECs, genes regulating BMP pathway were enriched in semilunar valves. In GAG VICs, MAPK pathway was specifically enriched in pulmonary valve, indicating development of different valves may need activation of different pathways. Interestingly, when comparing valve with pulmonary atresia versus healthy pulmonary valve using scRNA-seq, both MAPK related genes and GAG VICs were significantly reduced, suggesting impaired MAPK may contribute to pulmonary-specific loss of GAG VICs leading to its abnormal development. Conclusion: Our high-resolution atlas of human fetal valves revealed subtypes of VIC &amp; VEC with unique spatial locations. Comparison of four valves identified pulmonary valve-specific MAPK pathway that may explain loss of GAG VICs in patients with pulmonary atresia.

Risk Communication Model in Facing Tsunami Disaster Through Stakeholder Engagement

Umang Beach Club Private Island Resort is located in Sumur village, Pandeglang district, Banten. It has a very unique location, located at two sources of potential tsunamis. The first is Seismic, which is at the center of the megathrust of the Sunda Strait. The second, namely Unsesmic, is located at a distance of about 70km from Mount Anak Krakatu. This study aims to find a risk communication model in dealing with tsunami natural disasters through stakeholder engagement. This research uses descriptive qualitative method and data collection by interview, documentation and observation. Interviews were conducted with Umang Beach Club Private Island Resort, local government and disaster-related institutions, Sumur village communities, disaster communities as well as tsunami and risk management experts. The results of the study found a risk communication model in dealing with tsunami natural disasters through stakeholder engagement. Risk communication needs to be carried out in a systematic and planned manner and integrated with all stakeholders involved with disasters to reduce disaster risk.

Dendroclimatic signals in the pine and spruce chronologies in the Solovetsky Archipelago

Searching for a robust tree-ring parameter useful for paleoclimatic purposes is one of the most demanding topics in the modern paleoscience. Since Blue Intensity has already expressed itself in different geographical locations all over the world as a possible replacement for maximum density, close attention is paid to investigate features of the inferred signal. The Solovki Islands is a unique location in Northern Russia where two important factors that make this territory attractive for developing a long tree-ring chronology have been met: modern long-living trees and building activities using old trees that were started by monks in the middle of the 16th century. The main goal of the research is to develop pine and spruce chronologies based on tree-ring width (TRW) and delta Blue Intensity (dBI) and to assess the ability of these parameters to be used as climate predictors. As a result, 14 conifer chronologies from 7 sites (4 for pine and 3 for spruce) were developed. The composite pine and spruce chronologies span a period of 474 and 378 years each. Cross-correlation of dBI-based chronologies of both conifers is high (r = up to 0.71 while for TRW-based chronologies it is lower on average (−0.18 to 0.63). Intra-species correlation of TRW chronologies in some cases achieved even negative values (r = −0.18. Discrepancies found between TRW chronologies of pine and spruce could be explained by differences in climatic signals. Response function analysis with monthly temperatures revealed that growth of pine depends on the previous August, while spruce has a temporally stable and strong relation to June temperatures. Compared to TRW, dBI-based chronologies have a high correlation with summer temperatures (r = 0.64 and 0.66 for spruce and pine, respectively). Presented research points out the importance of the response function analysis suggesting that depending on goals of the study several tree-ring parameters could be used, e.g., tree-ring width of spruce responses to June temperatures, while dBI to the whole summer.

Geographic accessibility to public and private health facilities in Kenya in 2021: An updated geocoded inventory and spatial analysis.

To achieve universal health coverage, adequate geographic access to quality healthcare services is vital and should be characterized periodically to support planning. However, in Kenya, previous assessments of geographic accessibility have relied on public health facility lists only, assembled several years ago. Here, for the first time we assemble a geocoded list of public and private health facilities in 2021 and make use of this updated list to interrogate geographical accessibility to all health providers. Existing health provider lists in Kenya were accessed, merged, cleaned, harmonized, and assigned a unique geospatial location. The resultant master list was combined with road network, land use, topography, travel barriers and healthcare-seeking behavior within a geospatial framework to estimate travel time to the nearest (i) private, (ii) public, and (iii) both (public and private-PP) health facilities through a travel scenario involving walking, bicycling and motorized transport. The proportion of the population within 1 h and outside 2-h was computed at 300 × 300 spatial resolution and aggregated at subnational units used for decision-making. Areas with a high disease prevalence for common infections that were outside 1-h catchment (dual burden) were also identified to guide prioritization. The combined database contained 13,579 health facilities, both in the public (55.5%) and private-for-profit sector (44.5%) in 2021. The private health facilities' distribution was skewed toward the urban counties. Nationally, average travel time to the nearest health facility was 130, 254, and 128 min while the population within 1-h was 89.4, 80.5, and 89.6% for the public, private and PP health facility, respectively. The population outside 2-h were 6% for public and PP and 11% for the private sector. Mean travel time across counties was heterogeneous, while the population within 1-h ranged between 38 and 100% in both the public sector and PP. Counties in northwest and southeast Kenya had a dual burden. Continuous updating and geocoding of health facilities will facilitate an improved understanding of healthcare gaps for planning. Heterogeneities in geographical access continue to persist, with some areas having a dual burden and should be prioritized toward reducing health inequities and attaining universal health coverage.

Hyperspectral Reflectance for Measuring Canopy‐Level Nutrients and Photosynthesis in a Salt Marsh

AbstractSalt marsh ecosystems are underrepresented in process‐based models due to their unique location across the terrestrial–aquatic interface. Particularly, the role of leaf nutrients on canopy photosynthesis (FA) remains unclear, despite their relevance for regulating vegetation growth. We combined multiyear information of canopy‐level nutrients and eddy covariance measurements with canopy surface hyperspectral remote sensing (CSHRS) to quantify the spatial and temporal variability of FA in a temperate salt marsh. We found that FA showed a positive relationship with canopy‐level N at the ecosystem scale and for areas dominated by Spartina cynosuroides, but not for areas dominated by short S. alterniflora. FA showed a positive relationship with canopy‐level P, K, and Na, but a negative relationship with Fe, for areas associated with S. cynosuroides, S. alterniflora, and at the ecosystem scale. We used partial least squares regression (PLSR) with CSHRS and found statistically significant data–model agreements to predict canopy‐level nutrients and FA. The red‐edge electromagnetic region and ∼770 nm showed the highest contribution of variance in PLSR models for canopy‐level nutrients and FA, but we propose that underlying sediment biogeochemistry can complicate interpretation of reflectance measurements. Our findings highlight the relevance of spatial variability in salt marshes vegetation and the promising application of CSHRS for linking information of canopy‐level nutrients with FA. We call for further development of canopy surface hyperspectral methods and analyses across salt marshes to improve our understanding of how these ecosystems will respond to global environmental change.

Intracellular TMEM16A is necessary for myogenesis of skeletal muscle

Transmembrane protein 16A (TMEM16A) localizes at plasma membrane and controls chloride influx in various type of cells. We here showed an intracellular localization pattern of TMEM16A molecules. In myoblasts, TMEM16A was primarily localized to the cytosolic compartment and partially co-localized with intracellular organelles. The global deletion of TMEM16A led to severe skeletal muscle developmental defect. Invitro observation showed that the proliferation of Tmem16a-/- myoblasts was significantly promoted along with activated ERK1/2 and Cyclin D expression; the myogenic differentiation was impaired accompanied by the enhanced caspase 12/3 activation, implying enhanced endoplasmic reticulum (ER) stress. Interestingly, the bradykinin-induced Ca2+ release from ER calcium store was significantly enhanced after TMEM16A deletion. This suggested a suppressing role of intracellular TMEM16A in ER calcium release whereby regulating the flux of chloride ion across the ER membrane. Our findings reveal a unique location pattern of TMEM16A in undifferentiated myoblasts and its role in myogenesis.

Bring Your Own Location Data: Use of Google Smartphone Location History Data for Environmental Health Research.

Environmental exposures are commonly estimated using spatial methods, with most epidemiological studies relying on home addresses. Passively collected smartphone location data, like Google Location History (GLH) data, may present an opportunity to integrate existing long-term time-activity data. We aimed to evaluate the potential use of GLH data for capturing long-term retrospective time-activity data for environmental health research. We included 378 individuals who participated in previous Global Positioning System (GPS) studies within the Washington State Twin Registry. GLH data consists of location information that has been routinely collected since 2010 when location sharing was enabled within android operating systems or Google apps. We created instructions for participants to download their GLH data and provide it through secure data transfer. We summarized the GLH data provided, compared it to available GPS data, and conducted an exposure assessment for nitrogen dioxide () air pollution. Of 378 individuals contacted, we received GLH data from 61 individuals (16.1%) and 53 (14.0%) indicated interest but did not have historical GLH data available. The provided GLH data spanned 2010-2021 and included locations, capturing 66,677 participant days. The median number of days with GLH data per participant was 752, capturing 442 unique locations. When we compared GLH data to 2-wk GPS data (), 95% of GPS time-activity points were within of GLH locations. We observed important differences between exposures assigned at home locations compared with GLH locations, highlighting the importance of GLH data to environmental exposure assessment. We believe collecting GLH data is a feasible and cost-effective method for capturing retrospective time-activity patterns for large populations that presents new opportunities for environmental epidemiology. Cohort studies should consider adding GLH data collection to capture historical time-activity patterns of participants, employing a "bring-your-own-location-data" citizen science approach. Privacy remains a concern that needs to be carefully managed when using GLH data. https://doi.org/10.1289/EHP10829.

Seismic performance evaluation of code compliant and non-compliant RC walls

ABSTRACT Pakistan’s unique geographical location has made it seismically vulnerable. Owing to this, recentearthquakes have revealed the susceptibility of the existing reinforced concrete (RC)buildings in Pakistan. This has raised concerns about the structural performanceof RC buildings because mostmid-rise RC buildingsin Pakistan have shear wall lateral force resisting systems. In this study, a survey ofexisting mid-rise RC buildings in Pakistan's capital territory is used todevelop a database of existing RC shear walls. By using this database, this research aims to provide a seismic performance assessment of existing RC shear wallsto determine their deficiencies and provide necessary experimental data for retrofitting. TwoRC shear wall specimens SW1 and SW2, representing the characteristics of existingRC shear walls are testedunder quasi-static loading. The seismic response of the existing RC mid-risewalls isassessed through the mode of failure, hysteretic behavior, energy dissipation,flexure and shear stiffness,and curvaturedistribution.The findings reveal that the existing mid-rise RC walls in the region did notsatisfy the performance criteria recommended by different seismic codes. Hence a comprehensive retrofitting strategy with building codecompliance are prerequisites to avoid infrastructural and economic losses dueto seismic activity.

Population-based cohort study to assess the gingival lesions in 1319 patients with lichen planus.

Oral lichen planus (OLP) is a chronic immune disease. In this paper, we evaluated the overall characters, clinical presentation, and outcome of gingival lesions in OLP Italian patients. A retrospective cohort study was accomplished: a total of 1319 charts were investigated, of whom 922 were female (69.9%): 617 patients (46.8%) manifested white lesions and 702 red ones (53.2%). While most patients had several oral sites of involvement, the gingiva was the unique location in 103 cases. Symptoms were reported in 480 patients (36.4%): 286 patients with erosive OLP, 103 with atrophic form, and 91 with a white form. Long-lasting surveillance showed that only 40 patients (3.03%) had a total clinical signs remission. Regarding OLP medical treatment provided, patients attending less frequently a dental office underwent more often a specific therapy. To the best of our knowledge, this is the biggest collections of patients with gingival OLP ever described; exclusive gingival lesions are, however, rare and unlikely to undergo a malignant transformation. Moreover, gum lesions seemed to anticipate the appearance of oral lesions and a higher rate of OLP therapy was observed in patients with less frequent dental check-ups and oral hygiene instructions.

Kuiki Credit: scaling innovation in a growing fintech startup

Learning outcomes Following successful discussion of this case, students should be able to:▪ understand and apply the principles of effectuation;▪ understand the difficulty of obtaining traditional financing in Latin America;▪ determine the importance of matching new hire and company values, particularly in a small business; and▪ analyze some of the unique problems facing a business at the point of scaling up and provide suggestions for how the protagonist could address those problems. Case overview/synopsis This case provides an introduction to the Fintech industry in South and Central America, fruitfully combining tenets of the lean startup methodology, effectual principles of entrepreneurship and a novel method of managing personal finances via decentralized vehicles provided through fintech. In addition, Kuiki Credit and its use of fintech represent a compelling example of industry disruption by an entrepreneurial firm. Owing to its unique location, this case provides students with a lens into a part of the world rife with bureaucracy and, in some cases, corruption. The disruption is thus unique in that not only does one view traditional disruption of industry dynamics, but also government policy and cultural mores. This is evinced within the body of the case through direct quotes from founder Ernesto Leal and Eduardo Morán, one of the company’s first employees. This information highlights the market Kuiki Credit pursued, one underserved by traditional financing and thus lacking access to credit.Consistent with effectual entrepreneurship principles, Ernesto Leal, the main protagonist and a Nicaraguan entrepreneur, drew upon his significant corporate experience in financial institutions and as a franchise owner to create a new venture. Kuiki Credit is designed to increase access to capital and disseminate fintech throughout Central and South America, and in particular first in Costa Rica and later in Nicaragua. The case is set in 2018, when Leal faces a scaling issue. Specifically, he wonders how to maintain an entrepreneurial company with high levels of innovation and a culture of continuous improvement despite the need to grow. Near the end of the case, some specific issues relative to culture are briefly reviewed in relation to the sales department and Leal feeling the need to restructure the company, while being encouraged by the board to hit breakeven targets for three consecutive months prior to expanding to new markets. Complexity academic level This case most appropriately lends itself to discussions in entrepreneurship at the junior or senior undergraduate level. To engage in this case most productively, students should have a basic understanding of entrepreneurship, the equivalent of two to three weeks into the semester. Supplementary materials Teaching notes are available for educators only. Subject code CSS:3: Entrepreneurship.

Multiple migrations from East Asia led to linguistic transformation in NorthEast India and mainland Southeast Asia.

NorthEast India, with its unique geographic location in the midst of the Himalayas and Bay of Bengal, has served as a passage for the movement of modern humans across the Indian subcontinent and East/Southeast Asia. In this study we look into the population genetics of a unique population called the Khasi, speaking a language (also known as the Khasi language) belonging to the Austroasiatic language family and residing amidst the Tibeto-Burman speakers as an isolated population. The Khasi language belongs to one of the three major broad classifications or phyla of the Austroasiatic language and the speakers of the three sub-groups are separated from each other by large geographical distances. The Khasi speakers are separated from their nearest Austroasiatic language-speaking sub-groups: the “Mundari” sub-family from East and peninsular India and the “Mon-Khmers” in Mainland Southeast Asia. We found the Khasi population to be genetically distinct from other Austroasiatic speakers, i.e. Mundaris and Mon-Khmers, but relatively similar to the geographically proximal Tibeto Burmans. The possible reasons for this genetic-linguistic discordance lie in the admixture history of different migration events that originated from East Asia and proceeded possibly towards Southeast Asia. We found at least two distinct migration events from East Asia. While the ancestors of today’s Tibeto-Burman speakers were affected by both, the ancestors of Khasis were insulated from the second migration event. Correlating the linguistic similarity of Tibeto-Burman and Sino-Tibetan languages of today’s East Asians, we infer that the second wave of migration resulted in a linguistic transition while the Khasis could preserve their linguistic identity.

Role of income and government responsiveness in reducing the death toll from floods in Indian states

Floods are the most commonly occurring natural disasters in India due to India’s unique geographical location and socioeconomic conditions. Frequent flooding causes enormous loss of human lives and damage crops and public utilities. Furthermore, floods adversely affect economic development and increase the government's financial burden by increasing spending on various disaster mitigation measures. Recent empirical literature based on cross-national comparisons shows that disaster fatalities and damages are monotonically decreasing in per capita income. We challenge this view on the monotonic negative relationship between income and flood damages. We examine the non-monotonic (inverted U-shaped) relationship between per capita income and flood impact in terms of deaths, people affected, and damages due to floods in 19 major Indian states from 1980 to 2011, using Poisson and Tobit estimation methods. In particular, deaths and the population affected by floods increase with a turning point of income up to 882 US$ and 578 US$, respectively, and diminishes thereafter. Our results confirm an inverted U-shaped relationship between income and fatalities and the population affected by floods. In addition to income, we argue that government responsiveness plays an essential role in mitigating the risk of floods. We employ the fixed-effect Poisson estimation method to examine the government's role in protecting people against disaster risk, focusing on regional differences in India. Deaths from floods remain non-linear and follow the inverted U-pattern with respect to government responsiveness. However, the effect of government responsiveness on flood fatalities and flood damages is statistically insignificant. Our results further suggest that high-income states experience a lower death toll from floods. The high-income (rich) states are capable of incurring a higher threshold level of income and higher natural calamity expenditure to reduce flood fatalities and protect the population affected by floods than the low-income (poor) states. The poor states have minimal resources and face severe financial constraints to reduce the death toll from floods. From the perspective of public policy, the poor states, in particular, require an increase in income, better governance, and effective disaster management policies to mitigate flood impact.

The Physical Potential for Dutch Offshore Wind Energy

In the Netherlands, an important way to contribute toward achieving climate goals is the large-scale deployment of wind turbines in the North Sea. The North Sea is a unique location for offshore wind power thanks to its strong winds, shallow waters, and proximity to large energy users. Wind turbines generate electricity by extracting kinetic energy from the atmosphere. This kinetic energy is replenished at a finite rate through the mixing of atmospheric layers. The replenishment rate sets a physical limit to the amount of energy that can be sustainably extracted from a given area. In this study, we show that the Dutch Exclusive Economic Zone in the North Sea can sustainably host an installed capacity of approximately 59 GW on readily available space. By selecting areas fit for co-use, such as nature reserves and military zones, this amount can be increased to approximately 99 GW. With a calculated capacity factor of 45%, these areas can yield 240 and 381 TWh/yr, respectively, in the conservative and optimistic scenarios considered in this study, which correspond to approximately 39 and 62% of projected Dutch final energy demand in 2050. North Sea wind power is capable of supplying a significant amount of clean energy to Europe at large. Applying our approach to all North Sea countries combined implies that a capacity of approximately 418 GW can be sustainably installed in the North Sea under relatively conservative assumptions for water depth and distance from the shore. At a capacity factor of 43%, this can yield a power production level of as much as 1584 TWh/yr, which could satisfy approximately 40% of projected European electricity demand in 2050.

Bioinspired Collagen/Gelatin Nanopillared Films as a Potential Implant Coating Material.

Collagen-based Sharpey’s fibers are naturally located between alveolar bone and tooth, and they have critical roles in a well-functioning tooth such as mechanical stability, facile differentiation, and disease protection. The success of Sharpey’s fibers in these important roles is due to their unique location, vertical alignment with respect to tooth surface, as well as their micronanofiber architecture. Inspired by these structures, herein, we introduce the use of nanoporous anodic aluminum oxide molds in a drop-casting setup to fabricate biopolymeric films possessing arrays of uniform Collagen:Gelatin (Col:Gel) nanopillars. Obtained structures have diameters of ∼90 nm and heights of ∼300 nm, yielding significantly higher surface roughness values compared to their flat counterparts. More importantly, the nanostructures were parallel to each other but perpendicular to the underlying film surface imitating the natural collagenous structures of Sharpey’s fibers regarding nanoscale morphology, geometrical orientation, as well as biochemical content. Viability testing showed that the nanopillared Col:Gel films have high cell viabilities (over 90%), and they display significantly improved attachment (ca. ∼ 2 times) and mineralization for Saos-2 cells when compared to flat Col:Gel films and Tissue Culture Polystyrene (TCPS) controls, plausibly due to their largely increased surface roughness and area. Hence, such Sharpey’s fiber-inspired bioactive nanopillared Col:Gel films can be used as a dental implant coating material or tissue engineering platform with enhanced cellular and osteogenic properties.

Arctic science diplomacy of Norway: A case study of svalbard

Svalbard has undergone a major transformation since 1960s upon the Norwegian government's shifting focus from mining town into scientific activities. While the Spitsbergen Treaty provides a common ground for international scientific collaboration, the installation of satellite ground station by European Space Research Organization (ESRO) in Ny-Ålesund, Svalbard Satellite Station in Longyearbyen, and research activities propelled by Norwegian Polar Institute (NPI) has transformed Svalbard into one of the most prominent Arctic science diplomacy cases. Owing to its unique location and easy access opportunities for researchers, research facilities and substantial infrastructures well connected to international networks, professional and social research environment assuring safety routines and regulations as well as an assisting research strategy, the region is currently perceived as an international hub for Arctic research. On the other hand, Svalbard is expected to undergo further structural changes due to its international and transient population. This article aims to outline the Arctic science diplomacy of Norway based on the Svalbard case. Accordingly, the evolution of scientific communities in Svalbard is examined from a science diplomacy perspective. The future implications of structural changes within these communities are also discussed in the conclusion part.

Adapting a Telehealth Network for Emergency COVID-19 Pandemic Response, 2020-2021.

In March 2020, a tribal telehealth program—the Indian Country Extension for Community Health Outcomes (ECHO)—added emergency COVID-19 to its programming to support the pandemic response. A long-standing relationship with a network of Indian Health Service, tribal, and urban Indian clinicians supported a rapid launch of the COVID-19 telehealth program. This nationwide service offered primary care clinicians and staff serving American Indian/Alaska Native people access to virtual learning opportunities, expert clinical recommendations, technical assistance, and capacity building. From March 12, 2020, through April 30, 2021, the program provided 85 clinical sessions in 12 months, with an average participation of 120 attendees per clinic (N = 11 710). Attendees could complete a voluntary evaluation form for each session via an online link. A total of 2595 forms were completed. Attendees came from 33 states and 206 unique locations, primarily from the Pacific Northwest (n = 931, 35.9%). Most pharmacists (78.1%), providers (ie, medical doctor, doctor of osteopathy, advanced practice nurse, physician assistant, or clinical nurse midwife; 70.8%), and nurses (59.6%) gave the sessions the highest rating of “very satisfied.” The highest proportion of attendees indicating that they planned a change in practice were pharmacists (68.0%), nurses, (64.1%), and providers (61.3%). Most attendees (93.1%) said that the COVID-19 sessions gave them a sense of social support. Lessons learned were that (1) a telehealth platform can be quickly retasked for emergency response with no further delays, (2) a telehealth network can be scaled up quickly with participation from preexisting relationships, and (3) the platform is flexible and adaptable to the needs of participants. An existing telehealth program can be a key part of timely, relevant, large-scale emergency readiness and response efforts.

S1846 The GIST of Abdominal Pain With Jaundice

Introduction: Gastrointestinal Stromal Tumors (GISTs) are subepithelial neoplasms characterized by the expression of KIT protein (CD117 antigen). They are the most common non-epithelial neoplasms of the GI tract, often found in the stomach and distal small intestine, with small GISTs often undiagnosed. GISTs have malignant potential, but nodal involvement is rare, explaining why surgical resection is usually first line treatment. Adjuvant treatment following resection or neoadjuvant treatment in the setting of unresectable/metastatic GISTs may produce an improved median survival. We present a patient with painful jaundice found to have GIST. Case Description/Methods: A 70-year-old man with a history of lung cancer, coronary artery disease, and nephrolithiasis presented with waxing and waning diffuse abdominal pain occasionally radiating to the back for three weeks. Associated symptoms included increased eructation, decreased appetite, generalized weakness, steatorrhea, rust-colored urine, and jaundice. The pain worsened with fatty meals and improved with defecation. The patient appeared jaundiced with conjunctival icterus. Abdomen was soft, non-distended with right upper quadrant tenderness, voluntary guarding and hypoactive bowel sounds. Labs revealed a cholestatic pattern of liver enzymes indicating obstruction. Of note, the CA 19-9 level was 142. Biliary imaging was performed (Figure A), which showed peripancreatic mass and severe biliary stricture in the lower third of main bile duct (Figure B). Pathology results of fine needle biopsy indicated low-grade spindle cell neoplasm consistent with GIST, CD117, CD34 and smooth muscle actin positive, S-100 and desmin negative. Given the location of the tumor, elective robotic pancreaticoduodenectomy was performed two months later with nodal resection. Discussion: Historically, the presentation of painful jaundice is associated with extrahepatic cholestasis including intrinsic and extrinsic tumors (cholangiocarcinoma, pancreatic cancer), choledocholithiasis, primary sclerosing cholangitis, acute pancreatitis, sphincter of Oddi dysfunction or biliary tract strictures following invasive procedures. The unusual location of this patient’s GIST led to differential diagnoses that did not include his ultimate diagnosis. This case report highlights the presentation of an often undiagnosed cancer, GIST, especially given its unique location in the GI tract. It is vital that as clinicians we keep a broad differential while performing workups of abdominal pain with jaundice.Figure 1.: Biliary Imaging. A: RUQ abdominal ultrasound demonstrating hydropic gallbladder 11.5 cm in length with sludge. B: ERCP fluoroscopy showing evidence of biliary duct stricture.