Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion

Aims

Lumbar fusion is known to reduce the variation in pelvic tilt between standing and sitting. A flexible lumbo-pelvic unit increases the stability of total hip arthroplasty (THA) when seated by increasing anterior clearance and acetabular anteversion, thereby preventing impingement of the prosthesis. Lumbar fusion may eliminate this protective pelvic movement. The effect of lumbar fusion on the stability of total hip arthroplasty has not previously been investigated.

Patients and Methods

The Medicare database was searched for patients who had undergone THA and spinal fusion between 2005 and 2012. PearlDiver software was used to query the database by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural code for primary THA and lumbar spinal fusion. Patients who had undergone both lumbar fusion and THA were then divided into three groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The rate of dislocation in each group was established using ICD-9-CM codes. Patients who underwent THA without spinal fusion were used as a control group. Statistical significant difference between groups was tested using the chi-squared test, and significance set at p < 0.05.

Results

At one-year follow-up, 14 747 patients were found to have had a THA after lumbar spinal fusion (12 079 1 to 2 levels, 2594 3 to 7 levels, 74 8+ levels). The control group consisted of 839 004 patients. The dislocation rate in the control group was 1.55%. A higher rate of dislocation was found in patients with a spinal fusion of 1 to 2 levels (2.96%, p < 0.0001) and 3 to 7 levels (4.12%, p < 0.0001). Patients with 3 to 7 levels of fusion had a higher rate of dislocation than patients with 1 to 2 levels of fusion (odds ratio (OR) = 1.60, p < 0.0001). When groups were matched for age and gender to the unfused cohort, patients with 1 to 2 levels of fusion had an OR of 1.93 (95% confidence interval (CI) 1.42 to 2.32, p < 0.001), and those with 3 to 7 levels of fusion an OR of 2.77 (CI 2.04 to 4.80, p < 0.001) for dislocation.

Conclusion

Patients with a previous history of lumbar spinal fusion have a significantly higher rate of dislocation of their THA than age- and gender-matched patients without a lumbar spinal fusion. Cite this article: Bone Joint J 2017;99-B:585–91.

MARCOnI-ConvNet-Based MARker-Less Motion Capture in Outdoor and Indoor Scenes

Marker-less motion capture has seen great progress, but most state-of-the-art approaches fail to reliably track articulated human body motion with a very low number of cameras, let alone when applied in outdoor scenes with general background. In this paper, we propose a method for accurate marker-less capture of articulated skeleton motion of several subjects in general scenes, indoors and outdoors, even from input filmed with as few as two cameras. The new algorithm combines the strengths of a discriminative image-based joint detection method with a model-based generative motion tracking algorithm through an unified pose optimization energy. The discriminative part-based pose detection method is implemented using Convolutional Networks (ConvNet) and estimates unary potentials for each joint of a kinematic skeleton model. These unary potentials serve as the basis of a probabilistic extraction of pose constraints for tracking by using weighted sampling from a pose posterior that is guided by the model. In the final energy, we combine these constraints with an appearance-based model-to-image similarity term. Poses can be computed very efficiently using iterative local optimization, since joint detection with a trained ConvNet is fast, and since our formulation yields a combined pose estimation energy with analytic derivatives. In combination, this enables to track full articulated joint angles at state-of-the-art accuracy and temporal stability with a very low number of cameras. Our method is efficient and lends itself to implementation on parallel computing hardware, such as GPUs. We test our method extensively and show its advantages over related work on many indoor and outdoor data sets captured by ourselves, as well as data sets made available to the community by other research labs. The availability of good evaluation data sets is paramount for scientific progress, and many existing test data sets focus on controlled indoor settings, do not feature much variety in the scenes, and often lack a large corpus of data with ground truth annotation. We therefore further contribute with a new extensive test data set called MPI-MARCOnI for indoor and outdoor marker-less motion capture that features 12 scenes of varying complexity and varying camera count, and that features ground truth reference data from different modalities, ranging from manual joint annotations to marker-based motion capture results. Our new method is tested on these data, and the data set will be made available to the community.

Conversion of ammonia-pretreated switchgrass to biofuel precursors by bacterial-fungal consortia under solid-state and submerged-state cultivation

AIM

The aim of this study was to develop and evaluate bacterial-fungal communities to deconstruct switchgrass to biofuel precursors.

METHODS AND RESULTS

Bacterial-fungal consortia, mesophilic (25°C) and thermophilic (50°C), were enriched from switchgrass bales from which enzyme mixtures were used to deconstruct delignified switchgrass (DSG). The bacterial-fungal consortia were able to produce enzymes including endoglucanase, exoglucanase, β-glucosidase, xylanase, xylosidase and pectinase to convert DSG to soluble carbohydrates. 454 pyrosequencing revealed that Paenibacillus and Streptomyces were the dominant bacteria in the mesophilic and thermophilic consortia respectively. Penicillium and Acremonium were the dominant fungi in the mesophilic consortia, whereas Aspergillus and Penicillium were the dominant fungi present in the thermophilic consortia.

CONCLUSIONS

The results show that the state of cultivation, solid-state or submerged-state, affects the community structure as well as enzyme activities produced by these bacterial-fungal consortia. The enzyme mixture produced by the bacterial-fungal consortia released a higher amount of xylose than glucose during saccharification of DSG.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study provides a novel approach to produce enzymes for conversion of lignocellulolytic feedstocks to soluble sugars which can be used to produce biofuel precursors.

Functional Outcome Following Extensor Synovectomy and Excision of the Distal Ulna in Patients With Rheumatoid Arthritis

We prospectively measured hand and wrist function in rheumatoid patients undergoing excision of the distal ulna. Range of motion, visual analogue pain scores and grip strength were measured in 22 wrists, and the Jebsen hand function test was administered to seven patients, preoperatively and at 3 and 12 months. At 1 year there were improvements in forearm pronation ( P = 0.04), supination ( P = 0.03) and wrist extension ( P = 0.02), but a reduction in flexion ( P = 0.009). Active radial deviation was reduced and ulnar deviation increased. There was a significant improvement in grip strength ( P = 0.05) and reduction in wrist pain ( P = < 0.0001). At 1 year the Jebsen hand function test showed improvements in simulated feeding, stacking checkers, and lifting large empty cans. Excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function.

NEED OF IRON SUPPLEMENTATION IN GESTATIONAL DIABETES MELLITUS

Objective

Gestational diabetes mellitus (GDM) increases the foetal morbidity and mortality and there is also risk of development of type II diabetes for the mother. In pregnancy iron supplementations are given to all the females in India. Data are not available on the relationship between serum ferritin and GDM in Indian populations.

Material & Methods

Case control study was done on 90 women (30 GDM patients approx 28 weeks of gestation and 60 control subjects without GDM) referred to the tertiary care hospital at New Delhi. Ferritin was analysed by ELISA kit. They were analyzed for the correlation of ferritin with blood glucose in GDM patients.

Results

On comparison with blood glucose the levels of ferritin were statistically significantly high in GDM cases as compared to controls (p value 0.008). There was a negative correlation of ferritin with blood glucose level (r value -0.039, p value 0.794).

Discussion

Pregnancy is an equivalent of an inflammatory state and the high levels of ferritin can help in determining the need of iron supplementation given in pregnant females. Women who had high serum ferritin had the greatest risk of GDM.

Conclusion

This study suggests a possible link between elevated serum ferritin and low-grade inflammation. Further studies in larger populations are required to establish this study.

Gender identity disorder: Treatment and post-transition care in transsexual adults

As sex reassignment surgeries become more common and advanced, health professionals are more likely to see patients with gender identity disorders (GID) in their clinics. This can be challenging in many ways, and the challenges continue even after gender reassignment surgery as each case may present with unique anatomy. This article reviews the definition and treatment of GID, service provision in National Health Service and post-transition care of such patients.

Transient Weakening of Earth's Magnetic Shield Probed by a Cosmic Ray Burst

The GRAPES-3 tracking muon telescope in Ooty, India measures muon intensity at high cutoff rigidities (15-24 GV) along nine independent directions covering 2.3 sr. The arrival of a coronal mass ejection on 22 June 2015 18:40 UT had triggered a severe G4-class geomagnetic storm (storm). Starting 19:00 UT, the GRAPES-3 muon telescope recorded a 2 h high-energy (∼20  GeV) burst of galactic cosmic rays (GCRs) that was strongly correlated with a 40 nT surge in the interplanetary magnetic field (IMF). Simulations have shown that a large (17×) compression of the IMF to 680 nT, followed by reconnection with the geomagnetic field (GMF) leading to lower cutoff rigidities could generate this burst. Here, 680 nT represents a short-term change in GMF around Earth, averaged over 7 times its volume. The GCRs, due to lowering of cutoff rigidities, were deflected from Earth's day side by ∼210° in longitude, offering a natural explanation of its night-time detection by the GRAPES-3. The simultaneous occurrence of the burst in all nine directions suggests its origin close to Earth. It also indicates a transient weakening of Earth's magnetic shield, and may hold clues for a better understanding of future superstorms that could cripple modern technological infrastructure on Earth, and endanger the lives of the astronauts in space.

High correlation of clinical criteria in the diagnosis of drug-resistant TB and prevalence of ofloxacin resistance

OBJECTIVE

To study the drug resistance profile of patients with suspected multidrug-resistant tuberculosis (MDR-TB).

MATERIAL AND METHODS

This was a prospective study conducted among patients with suspected MDR-TB attending the Department of Respiratory Medicine, King George's Medical University, Lucknow, India, from August 2014 to April 2015. Sputum samples obtained from 50 such patients were subjected to drug susceptibility testing against first- and second-line drugs. Data on baseline characteristics were obtained from the patients and their previous medical records.

RESULTS

Mycobacterium tuberculosis was detected in 47/50 (94%) and non-tuberculous mycobacteria (NTM) in 3/50 (6%). Of the 47 patients with M. tuberculosis, 36 (76.6%) had MDR-TB: 24 (66.7%) of these had pre-extensively drug-resistant TB (pre-XDR-TB) and 4 (11.1%) had XDR-TB.

CONCLUSIONS

Among proven MDR-TB cases, approximately two thirds were pre-XDR-TB cases and more than 10% were XDR-TB cases. These form a sizeable proportion and may result in the failure of second-line treatment.

Improving the care of patients with severe open fractures of the tibia: the effect of the introduction of Major Trauma Networks and national guidelines

AIMS

The management of open lower limb fractures in the United Kingdom has evolved over the last ten years with the introduction of major trauma networks (MTNs), the publication of standards of care and the wide acceptance of a combined orthopaedic and plastic surgical approach to management. The aims of this study were to report recent changes in outcome of open tibial fractures following the implementation of these changes.

PATIENTS AND METHODS

Data on all patients with an open tibial fracture presenting to a major trauma centre between 2011 and 2012 were collected prospectively. The treatment and outcomes of the 65 Gustilo Anderson Grade III B tibial fractures were compared with historical data from the same unit.

RESULTS

The volume of cases, the proportion of patients directly admitted and undergoing first debridement in a major trauma centre all increased. The rate of limb salvage was maintained at 94% and a successful limb reconstruction rate of 98.5% was achieved. The rate of deep bone infection improved to 1.6% (one patient) in the follow-up period.

CONCLUSION

The reasons for these improvements are multifactorial, but the major trauma network facilitating early presentation to the major trauma centre, senior orthopaedic and plastic surgical involvement at every stage and proactive microbiological management, may be important factors.

TAKE HOME MESSAGE

This study demonstrates that a systemised trauma network combined with evidence based practice can lead to improvements in patient care.

Recursive Formulation of Operational Space Control

A recently developed spatial operator algebra approach to modeling and analysis of multibody robotic systems is used to develop O(n) recursive algorithms that compute the op erational space mass matrix and the operational space coriolis/centrifugal and gravity terms of an n-link serial manipulator. These algorithms enable an O(n) recursive im plementation of operational space control.

A Spatial Operator Algebra for Manipulator Modeling and Control

A recently developed spatial operator algebra for manipu lator modeling, control, and trajectory design is dis cussed. The elements of this algebra are linear operators whose domain and range spaces consist of forces, moments, velocities, and accelerations. The effect of these operators is equivalent to a spatial recursion along the span of a manipulator. Inversion of operators can be efficiently obtained via techniques of recursive filtering and smoothing. The operator algebra provides a high- level framework for describing the dynamic and kinematic behavior of a manipulator and for control and trajectory design algorithms. The interpretation of expressions within the algebraic framework leads to enhanced concep tual and physical understanding of manipulator dynamics and kinematics. Furthermore, implementable recursive algorithms can be immediately derived from the abstract operator expressions by inspection. Thus the transition from an abstract problem formulation and solution to the detailed mechanization of specific algorithms is greatly simplified.

Regression of invasive conjunctival squamous carcinoma in an HIV-positive patient on antiretroviral therapy

Case history of an African woman presenting with advanced HIV and a painful conjunctival lesion is presented. A conjunctival biopsy revealed invasive squamous cell carcinoma, with orbital invasion on computed tomography scan. She was commenced on antiretroviral therapy. She refused surgery to remove the eye and orbital contents (exenteration), and was referred to palliative care. Gradually, her immune status and ocular symptoms improved. At ophthalmic review, the tumour had apparently completely regressed. This unprecedented phenomenon may be due to antiretroviral therapy. Discussion covers conjunctival carcinoma and behaviour of HIV-related tumours with antiretroviral therapy. Antiretroviral drugs may offer a better alternative to disfiguring surgery in the future.

A liquid jet setup for x-ray scattering experiments on complex liquids at free-electron laser sources

In this paper we describe a setup for x-ray scattering experiments on complex fluids using a liquid jet. The setup supports Small and Wide Angle X-ray Scattering (SAXS/WAXS) geometries. The jet is formed by a gas-dynamic virtual nozzle (GDVN) allowing for diameters ranging between 1 μm and 20 μm at a jet length of several hundred μm. To control jet properties such as jet length, diameter, or flow rate, the instrument is equipped with several diagnostic tools. Three microscopes are installed to quantify jet dimensions and stability in situ. The setup has been used at several beamlines performing both SAXS and WAXS experiments. As a typical example we show an experiment on a colloidal dispersion in a liquid jet at the X-ray Correlation Spectroscopy instrument at the Linac Coherent Light Source free-electron laser.

Microbiome diversity in the sputum of patients with pulmonary tuberculosis

TB is a worldwide pandemic. India has the highest burden of TB, with WHO statistics for 2013 giving an estimated incidence figure of 2.1 million cases for India out of a global incidence of 9 million. Microbiota have been shown to be associated with many disease conditions; however, only few studies have been reported for microbiota associated with TB infection. For the first time, we characterized the composition of microbiota of TB patients of India, using high-throughput 16S rRNA gene sequencing and compared it with healthy controls. Phylum-level analysis showed that the relative abundance of Firmicutes and Actinobacteria was significantly higher in TB samples and Neisseria and Veillonella were two dominant genera after Streptococcus. In our study, significantly different core genera in TB and normal population were found as compared with the reported studies. Also, the presence of diverse opportunistic pathogenic microbiota in TB patients increases the complexity and diversity of sputum microbiota. Characterization of the sputum microbiome is likely to provide important pathogenic insights into pulmonary tuberculosis.

Taming Influenza Virus: Role of Antisense Technology

Human Influenza A virus (IAV), a relatively newer threat to mankind, is becoming invincible due to non availability of proper antiviral drug or effective long lasting vaccine against it. All existing measures to control this virus are overpowered by the phenomena of genetic shift and drift shown by Influenza A virus (IAV). Throughout the world, researchers are exploring the therapeutic potential of antisense technology (AST) to fight against this genetically variable virus. Antisense technology refers to the laboratory manipulation and/or modification of DNA or RNA so that its components (nucleotides) hybridize with target nucleic acid or mRNA or protein itself to inhibit the protein finally encoded. RNA inhibitory (RNAi) mechanism (particularly siRNA) seems to be the most promising among the different agents of AST. However, other agents like oligonucleotides, ribozymes and DNAzymes also show great potential. Decoys and aptamers, alone or in conjunction with other agents, are also being explored to inhibit the replication of virus. Presently, most of these agents have passed initial level of in vitro and in vivo experiments, passing through various levels of clinical trials but none of them has been approved for human purpose till date. Present review consolidates the efforts of researchers worldwide in this particular field and discusses the future perspectives this technology holds, to tame this notorious virus. Day by day, various areas of this technology are being explored and the day is not far when this chemical entity will reach from "bench to bedside".

Follicle-stimulating hormone-induced rescue of cumulus cell apoptosis and enhanced development ability of buffalo oocytes

The effect of follicle-stimulating hormone (FSH) on apoptotic status of cumulus cells, expression of proapoptotic and antiapoptotic genes, and development rate of in vitro fertilization-produced buffalo embryos were investigated. FSH supplementation in in vitro maturation-medium resulted in a dose-dependent reduction in the expression of proapoptotic genes namely, BCL2-associated X protein (BAX), cytochrome c, and caspase-3 and increase in the expression of antiapoptotic genes such as B-cell lymphoma 2 (BCL2) and X-linked inhibitor of apoptosis protein (XIAP) in cumulus cells of mature oocyte. Cumulus expansion, oocyte maturation, cleavage, and blastocyst development rates were significantly higher (P < 0.05) in 5 and 10-μg/mL FSH-supplemented groups as compared with control. Significant increase in the expression of FSH receptor messenger RNA was also found with 5 and 10-μg/mL FSH (P < 0.05). Terminal deoxynucleotidyl transferase dUTP nick end labeling assay confirmed that the population of apoptotic cumulus cells of matured oocytes was reduced in the FSH-treated groups as compared with control (P < 0.05). In conclusion, our data suggest that FSH may attenuate apoptosis in cumulus cells via mitochondria-dependent apoptotic pathway by increasing XIAP expression, resulting in a more favorable ratio of BCL2/BAX expression and decreasing the cytochrome c and caspase-3 expression, eventually contributing to developmental competence of oocytes. The information generated will help in improving the in vitro embryo production program in buffalo.

Scatter estimation and removal of anti-scatter grid-line artifacts from anthropomorphic head phantom images taken with a high resolution image detector

In radiography, one of the best methods to eliminate image-degrading scatter radiation is the use of anti-scatter grids. However, with high-resolution dynamic imaging detectors, stationary anti-scatter grids can leave grid-line shadows and moiré patterns on the image, depending upon the line density of the grid and the sampling frequency of the x-ray detector. Such artifacts degrade the image quality and may mask small but important details such as small vessels and interventional device features. Appearance of these artifacts becomes increasingly severe as the detector spatial resolution is improved. We have previously demonstrated that, to remove these artifacts by dividing out a reference grid image, one must first subtract the residual scatter that penetrates the grid; however, for objects with anatomic structure, scatter varies throughout the FOV and a spatially differing amount of scatter must be subtracted. In this study, a standard stationary Smit-Rontgen X-ray grid (line density - 70 lines/cm, grid ratio - 13:1) was used with a high-resolution CMOS detector, the Dexela 1207 (pixel size - 75 micron) to image anthropomorphic head phantoms. For a 15 × 15cm FOV, scatter profiles of the anthropomorphic head phantoms were estimated then iteratively modified to minimize the structured noise due to the varying grid-line artifacts across the FOV. Images of the anthropomorphic head phantoms taken with the grid, before and after the corrections, were compared demonstrating almost total elimination of the artifact over the full FOV. Hence, with proper computational tools, anti-scatter grid artifacts can be corrected, even during dynamic sequences.

Quantitative comparison using Generalized Relative Object Detectability (G-ROD) metrics of an amorphous selenium detector with high resolution Microangiographic Fluoroscopes (MAF) and standard flat panel detectors (FPD)

A novel amorphous selenium (a-Se) direct detector with CMOS readout has been designed, and relative detector performance investigated. The detector features include a 25μm pixel pitch, and 1000μm thick a-Se layer operating at 10V/μm bias field. A simulated detector DQE was determined, and used in comparative calculations of the Relative Object Detectability (ROD) family of prewhitening matched-filter (PWMF) observer and non-prewhitening matched filter (NPWMF) observer model metrics to gauge a-Se detector performance against existing high resolution micro-angiographic fluoroscopic (MAF) detectors and a standard flat panel detector (FPD). The PWMF-ROD or ROD metric compares two x-ray imaging detectors in their relative abilities in imaging a given object by taking the integral over spatial frequencies of the Fourier transform of the detector DQE weighted by an object function, divided by the comparable integral for a different detector. The generalized-ROD (G-ROD) metric incorporates clinically relevant parameters (focal-spot size, magnification, and scatter) to show the degradation in imaging performance for detectors that are part of an imaging chain. Preliminary ROD calculations using simulated spheres as the object predicted superior imaging performance by the a-Se detector as compared to existing detectors. New PWMF-G-ROD and NPWMF-G-ROD results still indicate better performance by the a-Se detector in an imaging chain over all sphere sizes for various focal spot sizes and magnifications, although a-Se performance advantages were degraded by focal spot blurring. Nevertheless, the a-Se technology has great potential to provide breakthrough abilities such as visualization of fine details including of neuro-vascular perforator vessels and of small vascular devices.

Meta-analysis of antibiotics for simple hand injuries requiring surgery

BACKGROUND

Simple hand trauma is very common, accounting for 1·8 million emergency department visits annually in the USA alone. Antibiotics are used widely as postinjury prophylaxis, but their efficacy is unclear. This meta-analysis assessed the effect of antibiotic prophylaxis versus placebo or no treatment on wound infection rates in hand injuries managed surgically.

METHODS

Embase, MEDLINE, PubMed, Cochrane Central, ClinicalTrials.gov and the World Health Organization International Clinical Trials Portal were searched for published and unpublished studies in any language from inception to September 2015. The primary outcome was the effect of antibiotic prophylaxis on wound infection rates. Open fractures, crush injuries and bite wounds were excluded. Study quality was assessed using the Cochrane risk-of-bias tool. Data were pooled using random-effects meta-analysis, and risk ratios (RRs) and 95 per cent c.i. obtained.

RESULTS

Thirteen studies (2578 patients) were included, comprising five double-blind randomized clinical trials, five prospective trials and three cohort studies. There was no significant difference in infection rate between the antibiotic and placebo/no antibiotic groups (RR 0·89, 95 per cent c.i. 0·65 to 1·23; P = 0·49). Subgroup analysis of the five double-blind randomized clinical trials (864 patients) again found no difference in infection rates (RR 0·66, 0·36 to 1·21; P = 0·18).

CONCLUSION

There was moderate-quality evidence that routine use of antibiotics does not reduce the infection rate in simple hand wounds that require surgery.

Defects in metal–organic frameworks: a compromise between adsorption and stability?

Defect engineering has arisen as a promising approach to tune and optimise the adsorptive performance of metal–organic frameworks.

Association between occupational history of exposure to tobacco dust and risk of carcinoma cervix: A case-control study

CONTEXT

Cervical cancer is the second most common malignancy among women in India. There is thus a need to identify unexplored risk factors such as occupational exposure to tobacco dust to justify its increasing trend so as to recommend suitable preventive measures.

AIMS

The aim was to study the association between occupational exposure to tobacco dust with development of carcinoma cervix.

SETTINGS AND DESIGN

Case-control study done in two tertiary care hospitals in Mangalore.

METHODOLOGY

239 histologically confirmed new cases of cervical cancer and the equivalent number of age-matched controls from 2011 to 2012 were interviewed about occupational history of beedi rolling and related factors.

STATISTICAL ANALYSIS

Chi-square test, unpaired t-test, logistic regression.

RESULTS

Exposure rate to tobacco dust following beedi rolling was 63 (26.4%) among cases and 38 (15.9%) among controls (P = 0.005, odds ratio [OR] =1.893). The latent period from occupational exposure of tobacco dust subsequent to beedi rolling and development of cervical cancer was found to be 26.5 ± 8.5 years. Adjusted OR of beedi rolling with development of cervical cancer was found to be 1.913 (P = 0.005) after controlling the confounding effect of tobacco usage and was 1.618 (P = 0.225) after controlling the effects of all confounders. Three-quarters of beedi rollers were working in conditions of inadequate ventilation and hardy anybody used face mask during work. About a quarter of participants underwent voluntary screening for cervical cancer.

CONCLUSION

Occupational exposure to tobacco dust was found to be associated with risk of developing cervical cancer. Measures to promote awareness, timely screening of this disease along with the improvement in working conditions is required for improving the health status of beedi rollers and to minimize the incidence of carcinoma cervix in the community.

Stearylated cycloarginine nanosystems for intracellular delivery – simulations, formulation and proof of concept

Novel cationic agent liposomes performed better in silico translating in higher cellular uptake with reduced toxicity.

Psychosomatic Medicine for Non-Psychiatric Residents: Video Education and Incorporation of Technology

OBJECTIVES

Psychiatric education for non-psychiatric residents varies between training programs, and may affect resident comfort with psychiatric topics. This study's goals were to identify non-psychiatric residents' comfort with psychiatric topics and to test the effectiveness of a video intervention.

METHODS

Residents in various departments were given a survey. They were asked to rank their comfort level with multiple psychiatric topics, answer questions about medical decision making capacity (MDMC), watch a 15-min video about MDMC, and answer a post-test section.

RESULTS

In total, 91 Internal Medicine, General Surgery, and Obstetrics and Gynecology residents responded to the study. Of the 91 residents, 55 completed the pre- and post-test assessments. There was no significant difference in correct responses. Residents' comfort levels were assessed, and a significant improvement in comfort level with MDMC was found.

CONCLUSIONS

This study highlights potential opportunities for psychiatric education, and suggests brief video interventions can increase resident physicians' comfort with a psychiatric topic.

Antenna-coupled photon emission from hexagonal boron nitride tunnel junctions

The ultrafast conversion of electrical signals to optical signals at the nanoscale is of fundamental interest for data processing, telecommunication and optical interconnects. However, the modulation bandwidths of semiconductor light-emitting diodes are limited by the spontaneous recombination rate of electron-hole pairs, and the footprint of electrically driven ultrafast lasers is too large for practical on-chip integration. A metal-insulator-metal tunnel junction approaches the ultimate size limit of electronic devices and its operating speed is fundamentally limited only by the tunnelling time. Here, we study the conversion of electrons (localized in vertical gold-hexagonal boron nitride-gold tunnel junctions) to free-space photons, mediated by resonant slot antennas. Optical antennas efficiently bridge the size mismatch between nanoscale volumes and far-field radiation and strongly enhance the electron-photon conversion efficiency. We achieve polarized, directional and resonantly enhanced light emission from inelastic electron tunnelling and establish a novel platform for studying the interaction of electrons with strongly localized electromagnetic fields.