The Use of Intravenous Zoledronate May Reduce Retear Rate after Rotator Cuff Repair in Older Female Patients with Osteoporosis: A First In-Human Prospective Study.

The objective of this study was to demonstrate the effect of intravenous (IV) zoledronate administration on rotator cuff healing, retear rate, and clinical outcomes in osteoporotic patients who underwent arthroscopic rotator cuff repair (ARCR) compared with patients with normal bone densities. In this prospective nonrandomized comparative study with propensity score matching, 30 patients who were postoperatively administered IV zoledronate (5 mg) were enrolled as the study group. The control group was matched using 1-to-2 propensity score matching. Radiologic and functional outcomes were evaluated 6 months after surgery. The functional scores in both groups exhibited significant improvement 6 months after surgery. Compared with Group 1 (osteoporosis with IV zoledronate injection) Group 2 (normal bone density) showed significant improvement in their University of California, Los Angeles (UCLA) shoulder score and Constant Shoulder Score (CSS) at 6 months postoperatively. The range of motion improved in both groups at 6 months after surgery. The retear rates according to Sugaya's classification (IV and V) were 13.3% (4 of 30 patients) and 25% (15 of 60 patients) in Groups 1 and 2, respectively, which established a non-inferiority of Group 1 to the control group. The retear pattern according to Rhee's classification in Group 1 was type I in all cases, whereas eight cases of type I and seven cases of type II patterns were observed in Group 2, which was statistically insignificant between the groups. In conclusion, anti-osteoporotic drug use is beneficial for patients with osteoporosis to reduce the failure rate after an ARCR of length > 2 cm, especially in older female patients. Moreover, thorough scrutiny is required to detect osteoporosis in patients with rotator cuff tears, especially in female patients.

Stamp-Perforation-Inspired Micronotch for Selectively Tearing Fiber-Bridged Carbon Nanotube Thin Films and Its Applications for Strain Classification.

Cracks typically deteriorate the structural and electrical properties of materials when not properly controlled. A few papers recently reported the controlling methods of crack formation in the brittle materials utilizing the lateral V-notch structure. For ductile materials, however, there have been few papers reporting cracking phenomenon, but full cracking control including predesigned initiation, propagation, and termination has not been reported yet. Therefore, we report a predesigned full cracking control in ductile conductive carbon nanotube (CNT) films by introducing inkjet-printed L-shape micronotch (LMN) structures inspired by directional stamp perforation marks. In spite of the high fracture toughness of CNT films, the LMNs determine locations of initial crack formation and guide crack propagation in a predesigned way. Selective connection of isolated cracks in the CNT film increases its resistance monotonically under tensile strain and thus tremendously well maintains high linearity (adj. R2 value > 0.99) in resistance change over record large strain ranges of 0.01-100%, which enables us to quantitatively classify strain values accurately for previously reported practical body signals for the first time. We believe that our facile printing-based crack control strategy not only provides a comprehensive solution to various stretchable sensor applications but also builds a new milestone for cracking mechanism studies in fracture mechanics.

Underwater maneuvering of robotic sheets through buoyancy-mediated active flutter.

Falling leaves flutter from side to side due to passive and intrinsic fluid-body coupling. Exploiting the dynamics of passive fluttering could lead to fresh perspectives for the locomotion and manipulation of thin, planar objects in fluid environments. Here, we show that the time-varying density distribution within a thin, planar body effectively elicits minimal momentum control to reorient the principal flutter axis and propel itself via directional fluttery motions. We validated the principle by developing a swimming leaf with a soft skin that can modulate local buoyancy distributions for active flutter dynamics. To show generality and field applicability, we demonstrated underwater maneuvering and manipulation of adhesive and oil-skimming sheets for environmental remediation. These findings could inspire future intelligent underwater robots and manipulation schemes.

Soft Modular Electronic Blocks (SMEBs): A Strategy for Tailored Wearable Health-Monitoring Systems.

Precise monitoring of human body signals can be achieved by soft, conformal contact and precise arrangement of wearable devices to the desired body positions. So far, no design and fabrication methodology in soft wearable devices is able to address the variations in the form factor of the human body such as the various sizes and shapes of individual body parts, which can significantly cause misalignments and the corresponding inaccurate monitoring. Here, a concept of soft modular electronic blocks (SMEBs) enabling the assembly of soft wearable systems onto human skin with functions and layouts tailored to the form factors of individuals' bodies is presented. Three types of SMEBs are developed as fundamental building blocks for functional modularization. The physical design of SMEBs is optimized for a mechanically stable island-bridge configuration. The prepared SMEBs can be integrated onto a target body part through rapid, room-temperature (RT) assembly (<5 s) using an oxygen plasma-induced siloxane bonding method. A soft metacarpophalangeal (MP) joints flexion monitoring system that is tailored to allow for accurate monitoring for multiple individuals with unique joint and hand sizes is demonstrated.

Considering the effect of groundwater on bioretention using the Storm Water Management Model.

The Storm Water Management Model (SWMM), with its recently released low impact development (LID) module, is among several models used for the performance evaluation of LID facilities in reducing runoff and pollutants. Modeling is often difficult because of the variety of factors affecting the LID system. Among these factors, the effect of groundwater can be important in the LID modeling results due to the possibility of its interaction with LID. In this study, the performance of the SWMM-LID controls in predicting runoff from bioretention cells was evaluated for a site under groundwater influence. In addition, for considering the groundwater effect in the model, this study explores the utility of the SWMM groundwater model in predicting runoff under groundwater influence. Runoff from the considered watershed draining into the bioretention cells was well-simulated with very favorable performance statistic values (r2 = 0.96, NSE = 0.94, % difference = 2.76). However, comparison of simulated with observed runoff from bioretention cells produced weaker statistical values (r2 = 0.69, NSE = 0.65, % difference = 18.22), which is thought to be due to the presence of events affected by groundwater interference. Removal of these events and recalibration were able to improve the overall results, suggesting that the influence of groundwater should be taken into account for better LID modeling of the study site. In order to consider the groundwater influence, the SWMM groundwater model was used in tandem with LID controls to provide an additional influent source to bioretention cells. This resulted in a good fit for two events which were thought to be impacted by groundwater (events in which outflow exceeded inflow) and overall better performance (r2 = 0.95, NSE = 0.95, % difference = 3.49) compared to the results obtained by using only LID controls. In conclusion, the SWMM groundwater model can help deal with groundwater-impacted events. However, for better representation of the phenomenon, the LID module itself needs to be improved to account for direct interaction with groundwater.

A Phenomenological Study of Parenting Stress Among Korean Mothers of Deaf Children.

Using phenomenological methods, the authors examined the kinds of parenting stresses experienced by Korean mothers of deaf children. The participants were 5 Korean mothers ages 45-50 years whose children's communication mode was spoken language. As a result of their data analysis, the researchers constructed 21 concepts and 7 categories, the categories being "Frustration with parenting their child," "Struggling between mainstream education and special education," "Continuing to be alienated from mainstream education settings," "Feeling left out and hurt in family relationships," "Making a sacrifice for the child," "Change in values of life," and "Importance of services meeting parents' needs." The study suggests the need for comprehensive support services that consider deaf children and their parents, siblings, families, and schools. The study also provides clinical implications for social work practice with families with deaf children from culturally diverse backgrounds.

Electronic skins for soft, compact, reversible assembly of wirelessly activated fully soft robots.

Designing softness into robots holds great potential for augmenting robotic compliance in dynamic, unstructured environments. However, despite the body's softness, existing models mostly carry inherent hardness in their driving parts, such as pressure-regulating components and rigid circuit boards. This compliance gap can frequently interfere with the robot motion and makes soft robotic design dependent on rigid assembly of each robot component. We present a skin-like electronic system that enables a class of wirelessly activated fully soft robots whose driving part can be softly, compactly, and reversibly assembled. The proposed system consists of two-part electronic skins (e-skins) that are designed to perform wireless communication of the robot control signal, namely, "wireless inter-skin communication," for untethered, reversible assembly of driving capability. The physical design of each e-skin features minimized inherent hardness in terms of thickness (<1 millimeter), weight (~0.8 gram), and fragmented circuit configuration. The developed e-skin pair can be softly integrated into separate soft body frames (robot and human), wirelessly interact with each other, and then activate and control the robot. The e-skin-integrated robotic design is highly compact and shows that the embedded e-skin can equally share the fine soft motions of the robot frame. Our results also highlight the effectiveness of the wireless inter-skin communication in providing universality for robotic actuation based on reversible assembly.

Modelling of suspended sediment in a weir reach using EFDC model.

Construction of hydraulic structures often leads to alteration of river dynamics and water quality. Suspended solids entering the upstream of the weir cause adverse effects to the hydroecological system and, therefore, it is necessary to build a modelling system to predict the changes in the river characteristics for proper water quality management. In this study, the discharges and total suspended solids upstream and downstream of the Baekje Weir installed in Geum River, Korea, was modelled using the environmental fluid dynamics code (EFDC) model. The resulting trend of four rainfall events shows that as rainfall increases, the total suspended solids (TSS) concentration increases as well. For the two larger events, at the upstream of the weir, TSS was observed to decrease or remain constant after the rainfall event depending on the lowering of the open gate. At the downstream, TSS supply was controlled by the weir during and after the rainfall event resulting in decline in the TSS concentration. The modelling produced good results for discharge based on %Diff. (4.37-6.35), Nash-Sutcliffe efficiency (NSE) (0.94-0.99) and correlation coefficient (r) (0.97-0.99) values as well as for TSS with acceptable values for %Diff. (12.08-14.11), NSE (0.75-0.81) and r (0.88-0.91), suggesting good applicability of the model for the weir reach of the river in the study site.

Association between type of reconstruction after Mohs micrographic surgery and surgeon-, patient-, and tumor-specific features: a cross-sectional study.

BACKGROUND: There are few data to indicate whether the type of final wound defect is associated with the type of post-Mohs repair. OBJECTIVE: To determine the methods of reconstruction that Mohs surgeons typically select and, secondarily, to assess the association between the method and the number of stages, tumor type, anatomic location, and patient and surgeon characteristics. METHODS: Statistical analysis of procedure logs of 20 representative young to mid-career Mohs surgeons. RESULTS: The number of stages associated with various repairs were different (analysis of variance, p < .001.). Linear repairs, associated with the fewest stages (1.5), were used most commonly (43-55% of defects). Primary repairs were used for 20.2% to 35.3% of defects of the nose, eyelids, ears, and lips. Local flaps were performed typically after two stages of Mohs surgery (range 1.98-2.06). Referral for repair and skin grafts were associated with cases with more stages (2.16 and 2.17 stages, respectively). Experienced surgeons were nominally more likely perform flaps than grafts. Regression analyses did not indicate any association between patient sex and closure type (p = .99) or practice location and closure type (p = .99). CONCLUSIONS: Most post-Mohs closures are linear repairs, with more bilayered linear repairs more likely at certain anatomic sites and after a larger number of stages.

Effects of land use change and water reuse options on urban water cycle.

The aim of this article was to study the effects of land use change and water reuse options on an urban water cycle. A water cycle analysis was performed on the Goonja drainage basin, located in metropolitan Seoul, using the Aquacycle model. The chronological effects of urbanization were first assessed for the land uses of the Goonja drainage basin from 1975 to 2005, where the ratio of impervious areas ranged from 43% to 84%. Progressive urbanization was identified as leading to a decrease in evapotranspiration (29%), an increase in surface runoff (41%) and a decrease in groundwater recharge (74%), indicating a serious distortion of the water cycle. From a subsequent analysis of the water reuse options, such as rainwater use and wastewater reuse, it is concluded that wastewater reuse seemed to have an advantage over rainwater use for providing a consistent water supply throughout the year for a country like Korea, where the rainy season is concentrated during the summer monsoon.

Factors affecting employment among people with mobility disabilities in South Korea.

Employment provides not only income but also opportunities for social participation. This is especially important for people with disabilities, but the employment of disabled people in many countries is subject to significant barriers. This study examines the actual state of employment of people with mobility disabilities in Korea and which characteristics affect employment among people with mobility disabilities. Analysis of responses to the Community Integration Questionnaire and independent variables among the study participants showed that the rate of employment among people with mobility disabilities (34.2%) is much lower than that of the general population (60.3%), with only 13.2% in full-time positions. Gender appeared to be a statistically significant factor influencing employment. Other demographic characteristics such as age, level of education and cohabitation did not influence employment in this study, but people with less severe disability had a higher probability of being employed. Disability acceptance appeared to be a vital factor in the process of vocational rehabilitation. The use of vocational rehabilitation services did not have a significant effect on employment. These results suggest that the role of the formal services system in the employment process of disabled people is insufficient.

Characteristics of washed-off pollutants and dynamic EMCs in parking lots and bridges during a storm.

Given the importance of water quality in drinking water sources, the Korean Ministry of Environment is designing and instigating the total maximum daily load (TMDL) program for major large rivers. For the successful implementation of this program, nonpoint pollutants resulting from various land uses should be controlled. Especially, paved areas such as parking lots and bridges are stormwater intensive land uses because of their high imperviousness and high pollutant mass emissions from vehicular activity. Vehicle emissions from these paved areas include various pollutants such as heavy metals, oil, grease and particulates. This research was conducted to investigate the magnitude and nature of the stormwater emissions with the goal of quantifying stormwater pollutant concentrations and mass emission rates from a parking lot and a bridge. Two monitoring sites in Kongju city were equipped with an automatic rainfall gauge and an automatic flow meter for measuring rainfall, water quality and runoff flow. This study presents the concentration changes during storm occurrence and event mean concentrations (EMCs) in the parking lot and bridge. The first flush criteria, a new concept explaining the relationship between EMC and the first flush effect, is also suggested using dynamic EMCs.

Merkel cell carcinoma.

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous cancer that predominately affects elderly Caucasians with fair skin and has a propensity for local recurrence and regional lymph node metastases. A variety of terms have been used to describe this tumor, including trabecular cell carcinoma, neuroendocrine or primary small cell carcinoma of the skin, and anaplastic cancer of the skin. Although the skin lesion is most commonly found on sun-exposed areas of the head and neck or extremities, it can occur on the trunk, genitalia, and perianal region. The median age is 69 years, but it may occur earlier and more frequently in immunosuppressed patients. Patients with MCC frequently present with a nonspecific erythematous or violaceous firm nodule or small plaque that may be surrounded by small satellite tumors. MCC usually arises in the dermis and extends into the subcutis. It may be difficult to accurately diagnose MCC by light microscopy alone and ancillary techniques, including electron microscopy and immunohistochemistry, may be necessary to make a definitive diagnosis. Management of MCC is dependent on stage of the disease and is hampered by its rarity and lack of randomized trials. Nonetheless, for localized disease most guidelines include wide local excision of the primary tumor either alone or with radiation therapy. Sentinel lymph node biopsy can be helpful in staging and prognosis, but its benefit in survival remains to be seen. Systemic chemotherapy, akin to regimens for small cell carcinoma of the lung, may be considered as an adjuvant following surgery or to treat locoregional or distant disease. The prognosis of MCC is variable. Some patients with localized disease have an indolent course and are well controlled with local excision alone. On the other hand, many tumors are aggressive and have a tendency for locoregional recurrence and distant metastases. Such patients have a grim prognosis with a median survival of 9 months. Successful outcomes are most often seen in patients with early diagnosis and complete excision.