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Mao H.,Philadelphia
Plastic and reconstructive surgery | Year: 2014

Several investigators have reported their clinical experience with medial pedis flaps for reconstruction of soft-tissue defects of the distal forefoot. However, they had only a few reports where this flap was used to repair soft-tissue defects of the great toe. Thus, reconstruction of soft-tissue defects of the great toe remains a challenge in reconstructive surgery. The authors describe the use of the medial pedis island flap to cover this region. This study was divided into two parts: an anatomic study and clinical application. In the anatomic study, 48 cadaveric feet were injected with latex, and then the main vessels distributed at the medial aspect of the foot were observed. Clinically, retrograde-flow medial pedis island flaps were harvested to cover the soft-tissue defects of the great toe in eight cases. An anatomic study revealed that the arterial circle under the first metatarsophalangeal joint and the arterial network on the surface of the abductor hallucis were responsible for the blood supply of the medial region of the foot. The diameter of the pedicle was great, and the pedicle was longer than previously reported. In terms of clinical application, all flaps were successful, without any significant complications. Using the arterial circle under the first metatarsophalangeal joint, the medial pedis island flap has a reliable retrograde blood supply. This flap should be considered as a preferential way of reconstructing soft-tissue defects of the great toe. Therapeutic, V. Source


Gersick A.S.,Princeton University | Cheney D.L.,University of Pennsylvania | Schneider J.M.,Philadelphia | Seyfarth R.M.,University of Pennsylvania | Holekamp K.E.,Michigan State University
Animal Behaviour | Year: 2015

Calls that catalyse group defence, as in the mobbing of predators, appear to facilitate cooperation by recruiting receivers to act collectively. However, even when such signals reliably precede cooperative behaviour, the extent to which the calls function as recruitment signals is unclear. Calls might simply arouse listeners' attention, setting off a cascade of independent responses to the threat. By contrast, they might convey information, for example, about signaller identity and the nature of a threat that affects receivers' decisions to participate. We explored this distinction by investigating a possible long-distance recruitment call used by spotted hyaenas. These social carnivores live in fission-fusion clans and individuals disperse widely within their territories. Putative recruitment calls must therefore attract receivers that are distant from the inciting threat and free to opt out of risky collective aggression. Hyaenas compete with lions over food, and neighbouring clans sometimes engage in violent border clashes. These high-stakes contests are decided based on numerical asymmetries, so hyaenas can only protect critical resources if the dispersed clan can converge quickly at conflict sites. We recorded and analysed whoop bouts produced in multiple contexts and found that bouts produced in response to signs of lion-hyaena conflict had shorter inter-whoop intervals than spontaneous 'display' bouts. In subsequent field playback experiments, resting hyaenas were significantly more likely to move in response to 'recruitment' bouts with shortened intervals than to otherwise identical 'display' bouts. Whereas only stimulus type predicted movement, lower-ranked subjects responded most quickly, perhaps because their feeding opportunities depend on arriving early at any kill site. Results demonstrate that hyaenas possess a signal that can reliably recruit allies across long distances, despite moderating effects of individual circumstances on the strength of receivers' responses. © 2015 The Association for the Study of Animal Behaviour. Source


Zindel L.R.,Philadelphia | Kranzler H.R.,University of Pennsylvania
Journal of studies on alcohol and drugs. Supplement | Year: 2014

Modern pharmacotherapy for alcohol dependence has its roots in the failure of National Prohibition in the United States and the rise of the disease model of alcoholism (embodied in Alcoholics Anonymous). In 1948, disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) to treat alcohol dependence, but its efficacy has not been supported by randomized controlled trials. In the 1960s, benzodiazepines replaced older treatments for alcohol withdrawal, but sedative and dependence-producing effects limit their utility in the postwithdrawal period. In the 1980s, the focus shifted to the treatment of co-occurring psychiatric disorders and medications that modify negative mood states, which contribute to relapse to heavy drinking. In the 1990s, developments in neurobiology implicated specific neurotransmitter systems underlying alcohol's effects, culminating in the 1994 approval by the FDA of the opioid antagonist naltrexone to treat alcohol dependence. In 2006, the FDA approved a long-acting formulation of naltrexone. Recently, nalmefene, another opioid receptor antagonist, was approved in Europe for as-needed use to reduce heavy drinking. Acamprosate, an amino acid derivative, first approved in France in 1989, received FDA approval in 2004. However, the beneficial effects of the approved medications are only modestly greater than those of placebo, and their use is limited. Topiramate, currently under investigation for alcohol dependence, has greater efficacy but a variety of adverse effects. In addition to the identification of novel compounds, the future of alcohol dependence pharmacotherapy will depend on developments in pharmacogenetics, in which genetic variation that moderates treatment efficacy and adverse effects is used to personalize treatment. Source


DelCore A.,Philadelphia | Herrera A.,University of Ottawa
2015 IEEE International Conference on Consumer Electronics, ICCE 2015 | Year: 2015

This paper describes the adoption of an open source hardware release process for a wearable headlamp as a way to improve prototyping and promote regionally-appropriate technology. The headlamp has been developed to satisfy a communicated need for hands-free, directional lighting that can be charged with renewable energy technology in remote areas that lack reliable electricity. The design of the headlamp emphasizes the importance of built-in resilience as way to achieve durability. Utilizing a highly-adaptable mechanical design accompanied with guiding design principles enables the headlamp to be implemented in an unlimited number of locations; during manufacture, the product will be embedded with locally-appropriate features that complement the materials and skills available in the region. Releasing the product with an open source hardware license fosters product adaptation for the design, manufacture, and use of the headlamp in various locations. Working prototypes have been developed, and kits are available under the IEEE open-source hardware license. © 2015 IEEE. Source


Mitchell L.A.,Philadelphia
Linacre Quarterly | Year: 2015

Character cannot be separated from the person. To be of good character means that one's habits, actions, and emotional responses all are united and directed toward the moral and the good. In this, public actions cannot be separated from private actions. Both sets of actions affect one's character. For example, a physician believes use of contraceptives to be immoral yet prescribes them in the office because he or she feels a duty to provide what the patient asks for, or a pharmacist who believes abortion to be immoral fills prescriptions for the abortifacient RU-486. These public acts affect one's character even if one's private belief is the opposite of the action. They leave traces on one's character. Not only do actions reflect the goodness or badness of one's character, one's actions also change one's character. The more one does an immoral action or recommends an immoral action for others, the more it becomes part of one's character to be the type of person who condones that immoral action. In order to be of good character one must not only know and desire the good, one must also pursue it in both private and public actions. Virtue is an aid in this; it is the act of good character. Growing in the virtues, especially prudence (knowing what to seek and what to avoid) forms good character. What is at stake is the integrity of the person. The physician who believes that use of contraception is immoral must also act in ways that display that belief and avoid actions that promote contraception use by his or her patients. © 2015 Catholic Medical Association. Source

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