Electro-chromic structure with a high degree of dielectric tunability

In conjunction with their electronically reconfigurable optical properties, inorganic, WO₃/LiNbO₃/NiO Electro-Chromic materials (EC) have recently been shown to exhibit a degree of electric field induced dielectric tunability at radio frequencies, to the level comparable with more mature bulk-tuneable technologies. However, the full extent of their dielectric tunability remains fully unexplored, due to a fundamental lack of understanding of its intricate tuning mechanisms. The unveiling of their tuning principles is paramount towards a comprehension of not only their optical and radio frequency dielectric tunability, but also for the creation of EC structures with substantial permittivity tuning ratios. Here, we report on an inorganic, WO₃ and LiNbO₃ – based EC structure with perturbed constituent layers. We developed and synthesised a new EC structure by inserting the chromic layers in the interior of the device and partitioning the electrolyte layer and assigning it to the device’s peripheries. This new arrangement allows for an increase in the dielectric tunability of over three times compared to previously reported standard EC structures in the frequency range from 1–20 GHz.

Eastern Canadian Colorectal Cancer Consensus Conference 2017

The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2017 was held in St. John's, Newfoundland and Labrador, 28-30 September. Experts in radiation oncology, medical oncology, surgical oncology, and cancer genetics who are involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics in the management of gastric, rectal, and colon cancer, including ■ identification and management of hereditary gastric and colorectal cancer (crc);■ palliative systemic therapy for metastatic gastric cancer;■ optimum duration of preoperative radiation in rectal cancer-that is, short- compared with long-course radiation;■ management options for peritoneal carcinomatosis in crc;■ implications of tumour location for treatment and prognosis in crc; and■ new molecular markers in crc.

High Frequency Dielectric Characteristics of Electrochromic, WO3 and NiO Films with LiNbO3 Electrolyte

A great deal of attention has been recently focused on Electrochromic (EC) materials and EC based devices, promoting mainly applications related to display technology. In this case, EC based displays are usually actuated by the application of low dc bias voltages, changing their appearance from transparent to opaque. A variety of studies related to the optical characteristics of EC materials have been reported, however, no serious studies so far have been reported on the possible high frequency tunability of the dielectric characteristics of these materials, with the exception of the work by Rose, which presented the operation of a microwave shutter based on conductive polymers operating in the X-band. Here we report tuneable high frequency dielectric characteristics of an Electrochromic (EC) cell with a complimentary structure of Conductor/WO₃/LiNbO₃/NiO/Conductor in the frequency range from 1 GHz to 20 GHz. The EC cell was prepared using standard semiconductor processing technology, such as lithography, etch and deposition techniques. Our measured results indicate that tunability of high frequency dielectric characteristics as a function of dc bias voltage is achieved, and that a possibility exists for this tunability to be tailored.

"Tiers of delay": warfarin, hip fractures, and target-driven care

Anticoagulation reversal is a common cause of operative delay. We sought to establish for the first time the impact this has on best practice tariff (BPT) for patients with hip fracture admitted on warfarin. All patients with hip fracture treated operatively over a 32-month period were reviewed. Basic demographics, time to theater, length of stay, and mortality were recorded for all patients. Independent samples t-tests were used to identify statistically significant differences between patients on warfarin and those not taking the drug. A total of 83 patients were admitted anticoagulated with a mean international normalized ratio of 2.65 and a median time to theater of 49.7 hours. Of these patients, 79% breached BPT, incurring significant financial loss. In the control group, 908 patients took a median 24.5 hours, a 28% breach of BPT (P < .01). Length of stay, Nottingham Hip Fracture Score, and predicted 30-day mortality were similar for both the groups. As well as affecting clinical outcome following hip fracture, delay due to anticoagulation causes considerable loss of BPT. Potential loss of revenue due to delays over the study period was £80 000, inspiring the establishment of an "early trigger" anticoagulation protocol. Although it is accepted that there are limitations to this work, it should raise awareness of the real impact of warfarin on patients with hip fracture both in terms of outcome and for the first time, loss of potential revenue.

The Best Practice Tariff helps improve management of neck of femur fractures: a completed audit loop

BACKGROUND

The Best Practice Tariff incentivizes hospitals in the UK to improve the care they deliver, and includes a requirement to deliver multiprofessional care to patients with neck of femur fractures. The Best Practice Tariff for 2010-11 included six targets: (1) surgery within 36 hours, (2) admission under consultant-led joint orthopaedic-geriatric care, (3) admission using a multidisciplinary assessment protocol, (4) review by a geriatrician within 72 hours, (5) geriatrician-directed multi-professional rehabilitation, and (6) assessment for falls and bone protection. The authors chose to audit their Trust's compliance with these targets.

METHODS

A retrospective audit was conducted in 2011 at the authors' university-affiliated tertiary care hospital, which is a regional major trauma centre. Only patients 65 years or older, with fragility-type neck of femur fractures who were treated surgically at the authors' unit and were eligible for geriatric review and multiprofessional rehabilitation, were included. The results of this audit (2010-11 Best Practice Tariff targets) were analysed and a series of procedural and logistical measures were introduced. A re-audit was performed in April 2012 for 2011-12, and the results for the 2 years were compared using appropriate statistics (Chi square tests and analysis of variance). Thirty-day mortality was compared using the summary hospital-level mortality indicator.

RESULTS

A total of 410 patients were eligible for Best Practice Tariff in 2010-11, which increased to 463 in 2011-12. The changes from the first year's audit helped increase the rates for 36-hour surgery from 48.3% to 73.4% and for 72-hour geriatric review from 68.8% to 81.8% (P<0.05). The annual Best Practice Tariff achievement increased from 31.7% to 61.3% (P<0.05). The summary hospital-level mortality indicator declined from 96.5 to 61.3.

CONCLUSIONS

Focusing on poorly satisfied Best Practice Tariff indicators can produce a significant improvement in the per capita Best Practice Tariff achievement. Further studies are needed to assess the health and financial gain in detail.

Optimising the use of electronic health records to estimate the incidence of rheumatoid arthritis in primary care: what information is hidden in free text?

Background

Primary care databases are a major source of data for epidemiological and health services research. However, most studies are based on coded information, ignoring information stored in free text. Using the early presentation of rheumatoid arthritis (RA) as an exemplar, our objective was to estimate the extent of data hidden within free text, using a keyword search.

Methods

We examined the electronic health records (EHRs) of 6,387 patients from the UK, aged 30 years and older, with a first coded diagnosis of RA between 2005 and 2008. We listed indicators for RA which were present in coded format and ran keyword searches for similar information held in free text. The frequency of indicator code groups and keywords from one year before to 14 days after RA diagnosis were compared, and temporal relationships examined.

Results

One or more keyword for RA was found in the free text in 29% of patients prior to the RA diagnostic code. Keywords for inflammatory arthritis diagnoses were present for 14% of patients whereas only 11% had a diagnostic code. Codes for synovitis were found in 3% of patients, but keywords were identified in an additional 17%. In 13% of patients there was evidence of a positive rheumatoid factor test in text only, uncoded. No gender differences were found. Keywords generally occurred close in time to the coded diagnosis of rheumatoid arthritis. They were often found under codes indicating letters and communications.

Conclusions

Potential cases may be missed or wrongly dated when coded data alone are used to identify patients with RA, as diagnostic suspicions are frequently confined to text. The use of EHRs to create disease registers or assess quality of care will be misleading if free text information is not taken into account. Methods to facilitate the automated processing of text need to be developed and implemented.

Good friends are hard to find? The social networks of people with mental illness 12 years after deinstitutionalisation

BACKGROUND

While community care is now well established in England, the development and maintenance of social networks of people with long-term mental illness remains a major challenge to services.

AIMS

To investigate the size of the social networks of people with long-term mental illness and the types of social support they receive in relation to their age and accommodation. Sample Thirty-nine men and 46 women (mean age: 61 years; range: 38-88). Forty nine (60%) were 65 years or under and 32 (40%) were over 65.

METHODS

Participants were interviewed using the Social Network Guide. Comparisons were made using generalised linear modelling.

RESULTS

Social networks (median 19; range 2-85) were generally larger than those reported in previous studies. Older residents (over 65 years) had closer ties than younger residents. Congregate types of community settings were relatively devoid of social supports.

CONCLUSION

Appropriate activities and social contexts are still needed to facilitate the social networks of people with mental illness, in particular, for those aged under 65 years.

Clinical and economic impact of contaminated blood cultures within the hospital setting

Blood cultures have an important role in the diagnosis of serious infections, although contamination of blood cultures (i.e. false-positive blood cultures) is a common problem within the hospital setting. The objective of the present investigation was to determine the impact of the false-positive blood culture results on the following outcomes: length of stay, hotel costs, antimicrobial costs, and costs of laboratory and radiological investigation. A retrospective case-control study design was used in which 142 false-positive blood culture cases were matched with suitable controls (patients for whom cultures were reported as true negatives). The matching criteria included age, comorbidity score and month of admission to the hospital. The research covered a 13-month period (July 2007 to July 2008). The findings indicated that differences in means, between cases and controls, for the length of hospital stay and the total costs were 5.4 days [95% CI (confidence interval): 2.8-8.1 days; P<0.001] and £5,001.5 [$7,502.2; 95% CI: £3,283.9 ($4,925.8) to £6,719.1 ($10,078.6); P<0.001], respectively. Consequently, and considering that 254 false-positive blood cultures had occurred in the study site hospital over a one-year period, patients with false-positive blood cultures added 1372 extra hospital days and incurred detrimental additional hospital costs of £1,270,381 ($1,905,572) per year. The findings therefore demonstrate that false-positive blood cultures have a significant impact on increasing hospital length of stay, laboratory and pharmacy costs. These findings highlight the need to intervene to raise the standard of blood-culture-taking technique, thus improving both the quality of patient care and resource use.

Pediatric oral health-related quality of life improvement after treatment of early childhood caries: a prospective multisite study

PURPOSE

This study's purpose was to compare changes in parent-reported pediatric oral health-related quality of life between children with early childhood caries (ECC) and children who were caries-free; the ECC children received surgical dental intervention between baseline and follow-up.

METHODS

A newly developed self-report instrument, the POQL, was administered to 501 parents of 2- to 8-year-old children (caries-free=315; ECC=186) in hospital dental clinics in Columbus, Ohio, and Washington, D.C.

RESULTS

At baseline, ECC children were more likely to have fair or poor oral health and were rated as having more pain and trouble with physical, mental, and social functioning due to their teeth or mouth vs caries-free children (P<.001). At 6 and 12 months following dental treatment for ECC, there were significant improvements in parental ratings of their children's oral health status and a significant reduction in problems reported with physical, mental, and social functioning (all P<.001).

CONCLUSIONS

Compared with caries-free children, early childhood caries children were more likely to have worse questionnaire response scores and to experience greater negative impacts on physical, mental, and social functioning. Dental interventions in ECC children had a significant positive impact on parental ratings of their overall oral health and physical, mental, and social functioning.

Genetic linkage of familial granulomatous inflammatory arthritis, skin rash, and uveitis to chromosome 16

Blau syndrome (MIM 186580), first described in a large, three-generation kindred, is an autosomal, dominantly inherited disease characterized by multiorgan, tissue-specific inflammation. Its clinical phenotype includes granulomatous arthritis, skin rash, and uveitis and probably represents a subtype of a group of clinical entities referred to as "familial granulomatosis." It is the sole human model with recognizably Mendelian inheritance for a variety of multisystem inflammatory diseases affecting a significant percentage of the population. A genomewide search for the Blau susceptibility locus was undertaken after karyotypic analysis revealed no abnormalities. Sixty-two of the 74-member pedigree were genotyped with dinucleotide-repeat markers. Linkage analysis was performed under a dominant model of inheritance with reduced penetrance. The marker D16S298 gave a maximum LOD score of 3.75 at theta = .04, with two-point analysis. LOD scores for flanking markers were consistent and placed the Blau susceptibility locus within the 16p12-q21 interval.

N-acetylgalactosaminyl GD1a is a target molecule for serum antibody in Guillain-Barré syndrome

Serum antibodies against such major glycolipids as GM1, GD1b, and LM1 have been reported in patients in the acute phase of Guillain-Barré syndrome (GBS). Because minor unidentified glycolipids also may be targets of antibodies in GBS sera, we assayed serum antibody against a crude ganglioside fraction using thin-layer chromatogram immunostaining. Antibody activity was detected against a band that migrated just below GD1a in 6 of the 50 patients with GBS tested. Antibody titer, as determined by enzyme-linked immunosorbent assay, decreased during the course of the disease. All 6 patients had suffered gastrointestinal infection before the neurological onset of GBS and showed low amplitudes for the compound muscle action potentials and normal or only slightly decreased nerve conduction velocities. Thin-layer chromatogram immunostaining did not show this antibody activity in any of the 16 normal and 119 disease controls. The unidentified glycolipid was isolated by DEAE-Sephadex A-25 column chromatography, sialidase treatment, and Iatrobeads column chromatography. Fast atom bombardment-mass spectra showed it to be N-acetyl-galactosaminyl GD1a.

Molecular computing for edge-enhanced laser imaging

In order to illustrate the self-assembly capability, we consider a laser imaging experiment on a wet film that is made of bacteriorhodopsin (BR) molecules suspended in a diffusion-limited viscous medium. BR wet film is similar to a wet photograph film but having a finer resolution and adaptive pixel locations due to laser-induced thermal diffusion. The synergism between thermal diffusion of BR molecules (induced externally by a write-laser) and molecular photochromism (generated internally by a read-laser) is exploited naturally for edge-enhanced image applications.

Expanded linkage map of Vibrio cholerae

An expanded linkage map of the Vibrio cholerae classical strain 162 chromosome has been prepared using a variety of new auxotrophic mutants. The chromosome consists of a single, linear linkage group. The map consists of 17 markers, which have been ordered; 20 mutational sites, which are tentatively ordered; five markers (ura-1, ser-2, mal-1, man-1, suc-1), which are linked but unordered; and three mutations (aro-2, cys-2 and cys-6) which showed little or no linkage. A proposal is made to standardize genetic nomenclature in V. cholerae genetic studies.

A study of the transmission and structure of double stranded RNAs associated with the killer phenomenon in Saccharomyces cerevisiae

Killer strains contain two double stranded RNAs, L and M. The M dsRNA appears to be necessary for production of a toxin and for resistance to that toxin. Mutant strains have been found that are defective in their ability to kill and in their resistance to toxin. These sensitive, non-killer strains have altered dsRNA composition. One class has no M dsRNA. Another class of sensitive, non-killers called suppressives has no M dsRNA but instead has smaller dsRNAscalledS. Indiploidsresulting from a cross of a wild-type killer by a suppressive the transmission of the M dsRNA is suppressed by the S dsRNA. When a suppressive is crossed by a strain with no M dsRNA, the diploids and all four meiotic spores have the S dsRNA characteristic of the parental suppressive strain. Suppressive strains do not suppress each other. Intercrosses between two different suppressives yields diploids with both parental S dsRNAs. These two S dsRNAs are transmitted to all 4 meiotic progeny. Another class of mutants has been found which is defective for one of the traits but retains the other. One type, temperature-sensitive killers, has a normal dsRNA composition but is unable to kill at 30 degrees. The other type, immunity-minus, has a complex dsRNA pattern. The immunity-minus strain is extremely unstable during mitotic growth and segregates several different types of non-killers. Analysis of the dsRNAs from wild type and the mutants by electron microscopy shows that the L, M, and S dsRNAs are linear. All strains regardless of killer phenotype appear to have the same size L dsRNA.

Mitochondrial proliferation within the nephron. I. Comparison of mitochondrial hyperplasia of tubular regeneration with compensatory hypertrophy

MITOCHONDRIAL PROLIFERATION IN THE RENAL PROXIMAL TUBULAR EPITHELIUM IN RESPONSE TO TISSUE LOSS HAS BEEN QUANTITATED BY TWO DIVERSE MODELS: acute tubular necrosis induced by mercuric chloride and unilateral nephrectomy. The increased work demand on the remaining tubular mass in both models has probably stimulated both cell hyperplasia and hypertrophy. In both instances, cell hyperplasia preceeds hypertrophy. During the cellular hypertrophy, mitochondria first proliferate in number and then increase in size; presumably to satisfy the greater need for energy metabolism necessary during increased active transtubular solute transport.

Repair of the nephron following injury with mercuric chloride

Images

Effects of Infrared Irradiation on the Tissues of the Rabbit

Images