Association of Intraoperative Opioid Administration With Postoperative Pain and Opioid Use

IMPORTANCE

Opioids administered to treat postsurgical pain are a major contributor to the opioid crisis, leading to chronic use in a considerable proportion of patients. Initiatives promoting opioid-free or opioid-sparing modalities of perioperative pain management have led to reduced opioid administration in the operating room, but this reduction could have unforeseen detrimental effects in terms of postoperative pain outcomes, as the relationship between intraoperative opioid usage and later opioid requirements is not well understood.

OBJECTIVE

To characterize the association between intraoperative opioid usage and postoperative pain and opioid requirements.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study evaluated electronic health record data from a quaternary care academic medical center (Massachusetts General Hospital) for adult patients who underwent noncardiac surgery with general anesthesia from April 2016 to March 2020. Patients who underwent cesarean surgery, received regional anesthesia, received opioids other than fentanyl or hydromorphone, were admitted to the intensive care unit, or who died intraoperatively were excluded. Statistical models were fitted on the propensity weighted data set to characterize the effect of intraoperative opioid exposures on primary and secondary outcomes. Data were analyzed from December 2021 to October 2022.

EXPOSURES

Intraoperative fentanyl and intraoperative hydromorphone average effect site concentration estimated using pharmacokinetic/pharmacodynamic models.

MAIN OUTCOMES AND MEASURES

The primary study outcomes were the maximal pain score during the postanesthesia care unit (PACU) stay and the cumulative opioid dose, quantified in morphine milligram equivalents (MME), administered during the PACU stay. Medium- and long-term outcomes associated with pain and opioid dependence were also evaluated.

RESULTS

The study cohort included a total of 61 249 individuals undergoing surgery (mean [SD] age, 55.44 [17.08] years; 32 778 [53.5%] female). Increased intraoperative fentanyl and intraoperative hydromorphone were both associated with reduced maximum pain scores in the PACU. Both exposures were also associated with a reduced probability and reduced total dosage of opioid administration in the PACU. In particular, increased fentanyl administration was associated with lower frequency of uncontrolled pain; a decrease in new chronic pain diagnoses reported at 3 months; fewer opioid prescriptions at 30, 90, and 180 days; and decreased new persistent opioid use, without significant increases in adverse effects.

CONCLUSIONS AND RELEVANCE

Contrary to prevailing trends, reduced opioid administration during surgery may have the unintended outcome of increasing postoperative pain and opioid consumption. Conversely, improvements in long-term outcomes might be achieved by optimizing opioid administration during surgery.

Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges

The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm²for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm²for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm²for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm²for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

The contribution of intermolecular spin interactions to the London dispersion forces between chiral molecules

Dispersion interactions are one of the components of van der Waals (vdW) forces that play a key role in the understanding of intermolecular interactions in many physical, chemical, and biological processes. The theory of dispersion forces was developed by London in the early years of quantum mechanics. However, it was only in the 1960s that it was recognized that for molecules lacking an inversion center, such as chiral and helical molecules, there are chirality-sensitive corrections to the dispersion forces proportional to the rotatory power known from the theory of circular dichroism and with the same distance scaling law R^-6 as the London energy. The discovery of the chirality-induced spin selectivity effect in recent years has led to an additional twist in the study of chiral molecular systems, showing a close relation between spin and molecular geometry. Motivated by it, we propose in this investigation to describe the mutual induction of charge and spin-density fluctuations in a pair A-B of chiral molecules by a simple physical model. The model assumes that the same fluctuating electric fields responsible for vdW forces can induce a magnetic response via a Rashba-like term so that a spin-orbit field acting on molecule B is generated by the electric field arising from charge density fluctuations in molecule A (and vice versa). Within a second-order perturbative approach, these contributions manifest as an effective intermolecular exchange interaction. Although expected to be weaker than the standard London forces, these interactions display the same R^-6 distance scaling.

AB0775 Efficacy, safety and survival of Secukinumab in spondyloarthritis

Background

Secukinumab (SCK) is a fully human monoclonal antibody that selectively inhibits IL-17A indicated for both axial and peripheral spondyloarthritis (SpA) and psoriatic arthritis (PsA). In this paper we present our experience with SCK since its approval, in a tertiary hospital.

Objectives

To describe the efficacy, survival and safety of SCK treatment in real clinical practice in patients with SpA and PsA.

Methods

We performed a descriptive, retrospective analysis of patients diagnosed with SpA according to ASAS criteria and PsA according to CASPAR criteria. For this purpose, data were collected from the medical records of 75 patients treated with SCK in the rheumatology service.

To evaluate efficacy in the Spa group, analytical variables (C-reactive protein (CRP)), the Ankylosing Spondylitis Disease Activity Score (ASDAS) scale and the patient’s visual analog scale (VAS) were analyzed. In the PA group, VAS and CRP were assessed at baseline and at 12 months. Survival was evaluated with respect to the causes of drug discontinuation and its association with individual baseline characteristics, such as metabolic syndrome. Safety was evaluated by analyzing intercurrent infections or neoplasms requiring discontinuation.

Results

Seventy-five patients with spondyloarthritis included in treatment with SCK were analyzed, 40 had Spa and 34 had PAs. The mean age at diagnosis was 45.1 years (SD 11.3) and the median time from diagnosis to onset of SCK was 4.5 years (IQR 1-10) (Table 1).

Table 1.

Baseline characteristics

SpAAPsTotalAge at diagnosis45.1 (SD11.8)44.9 (SD10.9)45.1 (SD11.3)Age at begging of SCK53.5 (SD 9.3)52.2 (SD 10)52.9 (9.6DE)Hypertension10 (25.0%)10 (29.4%)20 (27.0%)Dyslipidaemia17 (42.5%)17 (51.5%)34 (46.6%)Diabetes mellitus5 (12.5%)6 (17.6%)11 (14.9%)Body Mass Index27.9 (SD4.4)30.5 (SD8.4)29.2 (SD6.7)Tobacco14 (35.0%)10 (29.4%)24 (32.4%)Cardiovascular disease5 (12.5%)2 (5.9%)7 (9.5%)Previous sDMARD-Methotrexate13 (32.5%)24 (70.6%)37 (50%)-Leflunomide1.7% (15%)12 (35.3%)18 (24.2%)Initial corticosteroids7 (18.4%)15 (44.1%)22 (30.6%)

Fifty-seven patients (76%) were on treatment with anti-TNF prior to SCK initiation. The mean number of anti-TNF prior to SCK was 1.8 (SD 1.2). Twenty-six patients (35.1%) received were on treatment with SCK at a dose of 150 mg and 48 (64.9%) with 300 mg every 4 wk. The mean CRP before starting SCK was 8.46 mg/L (SD 18.38) and VAS 4.83 (SD 2.99).

Statistically significant improvement was observed in both pathologies in VAS (-2.1 SD 3.1) (p 0.003). Despite the improvement in CRP, in both groups of -3.7 mg/L (SD 15) was not statistically significant. Regarding ASDAS, in the Spa group, 2 patients (5.3%) showed great improvement (>3.1), 9 patients (23.7%) clinical improvement (>1.1), 17 patients (42.5%) improvement (<1.1), 6 patients (15%) showed no improvement and 4 patients (10.5%) worsening.

The overall drug survival to date is 19.41 months (SD 13.76), 20.6 months (SD 14.8) in the Spa group and 18 (SD 12.6) in the AP group (Figure 1).

Figure 1.

Secukinumab survival in both groups

17 patients (23%) discontinued treatment, with a median duration of 12 months (SD 4.66). 12 (70.6%) due to ineffectiveness, 1 (5.9%) by their own decision, 3 (17.6%) due to persistent mechanical pain and 1 (5.9%) due to neoplasia (gastric adenocarcinoma). The clinical variables of metabolic syndrome were evaluated (Table 1) none of these characteristics had a statistically significant association as a cause of drug discontinuation. No patient presented infections that required discontinuation of the drug. No association was detected between drug discontinuation or the development of metabolic syndrome.

Conclusion

In our cohort, SCK showed a statistically significant improvement in the VAS scale in both groups. A 23.7% of patients with Spa showed clinical improvement according to ASDAS values, 5.3% showed great improvement and 42.5% showed mild improvement. The overall drug survival to date is 19.41 months (SD 13.76) slightly longer in the SpA group than in APs. SCK seems to be a safe drug as none of our patients presented infections during its use.

Disclosure of Interests

None declared

AB0854 Descriptive and retrospective study of different types of spondyloarthritis and referral and diagnosis times

Background

Spondyloarthritis (SpA) is a group of inflammatory arthropathies of unknown aetiology that share several clinical, pathophysiological, serological and radiological features. In many cases the initial symptoms are insidious, leading to a delay in diagnosis and initiation of treatment. The time between the onset of symptoms and treatment is of vital importance for the prognosis of the disease.

Objectives

To describe the clinical characteristics of the SpA cohort, to analyse the number of months from symptom onset to referral to the rheumatology department and diagnosis of SpA, as well as differences according to the referring department.

Methods

Retrospective descriptive study of patients with a diagnosis of PsA according to the ASAS criteria and CASPAR criteria for the psoriatic arthritis subgroup (PsA), in a single hospital centre.

We collected demographic variables separated by subgroups of peripheral and axial SpA and PsA, age at diagnosis, time from symptom onset to referral to the rheumatology department and to diagnosis, as well as differences according to the department making the referral.

Results

Seventy-five patients with SpA were analysed, 40 had peripheral and axial SpA and 35 (46.66%) PsA. Thirty-six patients (49.3%) were female (Table 1). Patients with peripheral and axial SpA had a higher mean age at diagnosis than patients with PsA. 45.1 years (SD 11.3) was the mean age at diagnosis. 73.6% of patients were referred from primary care (PC), 9.4% from traumatology, 9.4% from rehabilitation (RH), 3.8% from dermatology and 3.8% from the emergency department. The median time from first symptom to referral to rheumatology was 31.4 (SD 57.2), 7.1 (SD 38.5), 21.7 (SD 51.4) months in peripheral and axial SpA, PsA and total respectively (Table 2). The service with the longest time between symptom onset and referral to rheumatology is PC and rehabilitation for all groups. The median time from first symptom to diagnosis was 43.1 (SD 55.1), 34.4 (SD 65.8) and 39.2 (SD 59.7) months for peripheral and axial SpA, PsA and total respectively (Table 2). The time from referral to rheumatology to diagnosis of peripheral and axial SpA was 12.2 (SD 19.4), PsA 17 (SD 39.3) and total 14.3(SD 29.5) months.

Table 1.

Demographic characteristics and time in months according to type of SpA.

Peripheral and axial SpAPsATotalAge at diagnosis45.1 (SD11.8)44.9 (SD10.9)45.1 (SD11.3)Female20 (51.3%)16 (47.1%)36 (49.3%)Hypertension10 (25.0%)10 (29.4%)20 (27.0%)Dyslipidaemia17 (42.5%)17 (51.5%)34 (46.6%)Diabetes mellitus5 (12.5%)6 (17.6%)11 (14.9%)Body Mass Index27.9 (SD4.4)30.5 (SD8.4)29.2 (SD6.7)Cardiovascular disease5 (12.5%)2 (5.9%)7 (9.5%)Cerebrovascular disease2 (5.0%)2 (5.9%)4 (5.4%)Depression1 (2.5%)1 (2.9%)2 (2.7%)Renal insufficiency1 (2.5%)1 (3.0%)2 (2.7%)Liver failure3 (7.5%)5 (14.7%)8 (10.8%)Time in months from 1st symptom to referral31.4 (SD57.2)7.1 (SD38.5)21.7 (SD51.4)  1Primary care30.9(SD10.9)7.01(SD34.1)21.07(SD35.2)  1Traumatology5 (SD1.25)5 (SD2.82)5 (SD1.48)  Rehabilitation36 (SD29.14)1927.5 (SD24.75)  7Dermatology13 (SD1.41)13 (SD1.41)  3Emergency service111Time from referral to diagnosis12.2 (SD19.4)17.0 (SD39.3)14.3 (SD29.5)Time from 1st symptom to diagnosis43.1 (SD55.1)34.4 (SD65.8)39.2 (SD59.7)

Conclusion

In our cohort, patients are referred to rheumatology mainly from PC, which in turn is the service with the longest delay, especially in the peripheral and axial SpA group. Patients with PsA take less time to be referred than patients with peripheral and axial SpA. Once referred to rheumatology, peripheral and axial SpA patients take less time to be diagnosed than those in the PsA group.

Disclosure of Interests

None declared

A nanographene disk rotating a single molecule gear on a Cu(111) surface

On Cu(111) surface and in interaction with a single hexa-tert-butylphenylbenzene molecule-gear, the rotation of a graphene nanodisk was studied using the large-scale atomic/molecular massively parallel simulator molecular dynamics simulator. To ensure a transmission of rotation to the molecule-gear, the graphene nanodisk is functionalized on its circumference bytert-butylphenyl chemical groups. The rotational motion can be categorized underdriving, driving and overdriving regimes calculating the locking coefficient of this mechanical machinery as a function of external torque applied to the nanodisk. The rotational friction with the surface of both the phononic and electronic contributions is investigated. For small size graphene nanodisks, the phononic friction is the main contribution. Electronic friction dominates for the larger disks putting constrains on the experimental way of achieving the transfer of rotation from a graphene nanodisk to a single molecule-gear.

Emotion production of facial expressions: A comparison of deaf and hearing children

The production of facial expressions is an important skill that allows children to share and adapt emotions during social interactions. While deaf children are reported to show delays in their social and emotion understanding, the way in which they produce facial expressions of emotions has been relatively unexplored. The present study investigated the production of facial expressions of emotions by young congenitally deaf children. Six facial expressions of emotions produced by 5 congenitally deaf children and 5 hearing children (control group) were filmed across three tasks: 1) voluntarily posed expression of emotion 2) responding to social stories 3) intentionally mimicking expressions of emotion. The recorded videos were analysed using a software based of the Facial Action Coding System (FACS), and then judged by adult raters using two different scales: according to the emotion elicited (i.e. accuracy) and the intensity of the emotion produced. The results of both measurement scales showed that all children (deaf and hearing) were able to produce socially recognisable prototypical configuration of facial expressions. However, the deaf children were rated by adults as expressing their emotions with greater intensity compared to the hearing children. The results suggest deaf children may show more exaggerated facial expressions of emotion, possibly to avoid any ambiguity in communication.

POS1355 THE REMITTING SERONEGATIVE SYMMETRICAL SYNOVITIS WITH PITTING EDEMA SYNDROME (RS3PE): REVIEW OF TEN YEARS AT A REFERENCE HOSPITAL

Background:

The Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome (RS3PE) is a rare rheumatological disease, considered a benign process.

Objectives:

This study aims to describe its clinical features and serological markers, and also to analyze its possible association with neoplasms.

Methods:

An observational retrospective study was performed to assess demographic and clinical characteristics of patients diagnosed from RS3PE at a reference hospital amongst the Rheumatology and Internal Medicine departments, from 2010 to 2021.

Results:

Twenty-seven patients were included, with a mean age of 82.74 y.o. (IC95% 80.45-85.04; range 66 to 93), and a 51.85% proportion of males. Only 22.22% were from rural areas.

All patients presented bilateral hand edema although some associated feet edema (40.74%) or morning stiffness (70.37%). Blood tests demonstrated anemia in 44.44% of patients. Inflammatory markers were elevated, such as C-Reactive Protein (29.23 mg/L, IC95% 18.17-40.29), erythrocyte-sedimentation rate (33.74 mm/hour, IC95% 24.22-43.26) and fibrinogen (531.6 mg/dL, IC95% 482.91-580.30). Only a few patients presented any autoimmune serological marker such as antinuclear antibodies (18.18%) or rheumatoid factor (8.70%).

X-ray screening was realized to 22 patients. 14 showed of osteoarthritis radiologic presentation, 4 had radiological findings of chondrocalcinosis and one of them presented both. Only one patient had bone erosion.

Malignancy screening was performed at diagnosis in only 29.63% of patients (all negative). During follow-up only two tumors were detected (mean accumulated follow-up: 40.37 months, IC95% 26.70-54.04; range 1 to 122) and there were adenocarcinoma primary neoplasms.

All but one patient received low-dose corticosteroids, with a good and rapid response in all cases. Three patients received treatment with methotrexate (2) or leflunomide (1).

Conclusion:

RS3PE must be contemplated in elderly patients presenting with bilateral hand pitting edema and articular symptoms. No specific biomarkers have been described, but inflammatory reaction is often found in the absence of rheumatoid arthritis biomarkers. Rapid response to corticosteroids is prevalent. Only two neoplasms were detected during follow-up.

References:

[1]Paira S, Graf C, Roverano S, Rossini J. Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases. Clin Rheumatol. 2002 May;21(2):146-9. doi: 10.1007/pl00011218. PMID: 12086166.

[2]Cobeta García JC, Martínez Burgui J. RS3PE syndrome or benign edematous polysynovitis in the elderly. Study of 8 cases. Rev Clin Esp. 1999 Dec;199(12):785-9. Spanish. PMID: 10687410.

[3]Moreno Obregón F, Del Castillo Madrigal M, Díaz Narváez F, Pérez Delgado FJ. RS3PE syndrome with positive rheumatoid factor. Reumatol Clin. 2019 Nov-Dec;15(6):e168-e169. English, Spanish. doi: 10.1016/j.reuma.2017.11.009. Epub 2017 Dec 15. PMID: 29254743

Disclosure of Interests:

None declared

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Proposals for person-centred care in the COVID-19 era. Delphi study

BACKGROUND

In this COVID-19 era, we need to rethink the criteria used to measure the results of person-centred care strategies.

OBJECTIVE

To identify priorities, and criteria that health services can use to pursue actually the goal of achieving person-centred care.

DESIGN

Three-phase online qualitative study performed during May-July of 2020 using the Delphi technique.

SETTING AND PARTICIPANTS

An online platform was used for a consensus meeting of 114 participants, including health planning experts, health-care institution managers, clinicians and patients.

MAIN OUTCOME MEASURES

Criteria and indicators for the achievement of person-centred care.

MAIN RESULTS

The first round began with 125 proposals and 11 dimensions. After the second round, 28 ideas reached a high level of consensus among the participants. Ultimately, the workgroup agreed on 20 criteria for goals in the implementation of person-centred care during the COVID-19 era and 21 related indicators to measure goal achievement.

DISCUSSION

Nine dimensions and 28 priorities were identified. These priorities are also in accordance with the quadruple aim approach, which emphasizes the need for care for health-care professionals, without whom it is impossible to achieve a better quality of care.

CONCLUSIONS

Person-centred care continues to be a key objective. However, new metrics are needed to ensure its continued development during the restoration of public health services beyond the control of COVID-19.

PATIENT OR PUBLIC CONTRIBUTION

Twelve professionals and patient representatives participated voluntarily in the construction of the baseline questionnaire and in the selection of the criteria and indicators using an online platform for consensus meetings.

Intraoperative Low Alpha Power in the Electroencephalogram Is Associated With Postoperative Subsyndromal Delirium

Background

Postoperative delirium (PD) and subsyndromal delirium (PSSD) are frequent complications in older patients associated with poor long-term outcome. It has been suggested that certain electroencephalogram features may be capable of identifying patients at risk during surgery. Thus, the goal of this study was to characterize intraoperative electroencephalographic markers to identify patients prone to develop PD or PSSD.

Methods

We conducted an exploratory observational study in older patients scheduled for elective major abdominal surgery. Intraoperative 16 channels electroencephalogram was recorded, and PD/PSSD were diagnosed after surgery with the confusion assessment method (CAM). The total power spectra and relative power of alpha band were calculated.

Results

PD was diagnosed in 2 patients (6.7%), and 11 patients (36.7%) developed PSSD. All of them (13 patients, PD/PSSD group) were compared with patients without any alterations in CAM (17 patients, control group). There were no detectable power spectrum differences before anesthesia between both groups of patients. However, PD/PSSD group in comparison with control group had a lower intraoperative absolute alpha power during anesthesia (4.4 ± 3.8 dB vs. 9.6 ± 3.2 dB, p = 0.0004) and a lower relative alpha power (0.09 ± 0.06 vs. 0.21 ± 0.08, p < 0.0001). These differences were independent of the anesthetic dose. Finally, relative alpha power had a good ability to identify patients with CAM alterations in the ROC analysis (area under the curve 0.90 (CI 0.78-1), p < 0.001).

Discussion

In conclusion, a low intraoperative alpha power is a novel electroencephalogram marker to identify patients who will develop alterations in CAM - i.e., with PD or PSSD - after surgery.

Green function, quasi-classical Langevin and Kubo-Greenwood methods in quantum thermal transport

With the advances in fabrication of materials with feature sizes at the order of nanometers, it has been possible to alter their thermal transport properties dramatically. Miniaturization of device size increases the power density in general, hence faster electronics require better thermal transport, whereas better thermoelectric applications require the opposite. Such diverse needs bring new challenges for material design. Shrinkage of length scales has also changed the experimental and theoretical methods to study thermal transport. Unsurprisingly, novel approaches have emerged to control phonon flow. Besides, ever increasing computational power is another driving force for developing new computational methods. In this review, we discuss three methods developed for computing vibrational thermal transport properties of nano-structured systems, namely Green function, quasi-classical Langevin, and Kubo-Green methods. The Green function methods are explained using both nonequilibrium expressions and the Landauer-type formula. The partitioning scheme, decimation techniques and surface Green functions are reviewed, and a simple model for reservoir Green functions is shown. The expressions for the Kubo-Greenwood method are derived, and Lanczos tridiagonalization, continued fraction and Chebyshev polynomial expansion methods are discussed. Additionally, the quasi-classical Langevin approach, which is useful for incorporating phonon-phonon and other scatterings is summarized.

Multiple Submucosal Out-Fracture of the Inferior Turbinates: Evaluation of the Results by Acoustic Rhinometry

A multiple submucosal out-fracture of the inferior turbinates was made in 21 patients with nasal obstruction due to hypertrophy of the inferior turbinates. Before surgery, an endoscopic evaluation and an acoustic rhinometry was performed in all the cases. The operation was done under general anesthesia and bilaterally in all the patients. Three months after surgery, a postoperative acoustic rhinometry was done and an increase of the minimal cross-section area was achieved in all the cases. Acoustic rhinometry performed in 100 normal cases was used as a control group.

Paediatric interventional cardiology in Costa Rica: diagnostic reference levels and estimation of population dose

The goal of the present study was to propose a set of national diagnostic reference levels (DRLs) in Costa Rica for paediatric interventional cardiology (IC) procedures classified by age and weight and to estimate the collective dose of the paediatric population from these intervention practices. The data collection period was May 2016 to May 2017. The third quartile of patient dose data distributions for kerma-area product (KAP) values was set as the national DRLs. A sample of 154 paediatric IC procedures (collected in the national paediatric hospital with a single x-ray system) was used and divided into four age ranges and five weight ranges. The national DRLs obtained for KAPs by age range were 1.79 Gy cm² (<1 year) to 23.0 Gy cm² (10-15 years). The national DRLs obtained for KAPs by weight range were 1.0 Gy cm² (<10 kg) to 49.6 Gy cm² (50-79 kg). The contribution to the collective dose of the population of Costa Rica amounted to 0.78 person Sv.

The Next Generation of Training for Arabidopsis Researchers: Bioinformatics and Quantitative Biology

Training for experimental plant biologists needs to combine bioinformatics, quantitative approaches, computational biology, and training in the art of collaboration, best achieved through fully integrated curriculum development.

Measuring molar movement: A reliable technique

A technique of accurately assessing left and right maxillary molar movement is described, using superimposition of digital study models. This method has distinct advantages over the traditional method of measuring tooth movement using cephalometric radiographs.

Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation. A randomized, multicenter, hemoglobin-stratified, double-blind, fibrinogen-versus-saline-controlled trial was conducted. The primary end point was the percentage of patients requiring red blood cells. We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group. We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group. Nine patients in the saline group (20.9%) required fibrinogen at graft reperfusion (compared with one patient [2.1%] in the fibrinogen group; p = 0.005). Blood was transfused to 52.9% (95% confidence interval [CI] 42.5-63.3%) in the fibrinogen group and 42.74% (95% CI 28.3-57.2%) in the saline group (p = 0.217). Relative risk for blood transfusion was 0.80 (95% CI 0.57-1.13). Thrombotic events occurred in one patient (2.1%) and five patients (11.4%) in the fibrinogen and saline groups, respectively. Seven patients (14.6%) in the fibrinogen group and nine (20.3%) in the saline group required reoperation. Preemptive administration of fibrinogen concentrate did not influence transfusion requirements.

Molecular design driving tetraporphyrin self-assembly on graphite: a joint STM, electrochemical and computational study

Tuning the intermolecular interactions among suitably designed molecules forming highly ordered self-assembled monolayers is a viable approach to control their organization at the supramolecular level. Such a tuning is particularly important when applied to sophisticated molecules combining functional units which possess specific electronic properties, such as electron/energy transfer, in order to develop multifunctional systems. Here we have synthesized two tetraferrocene-porphyrin derivatives that by design can selectively self-assemble at the graphite/liquid interface into either face-on or edge-on monolayer-thick architectures. The former supramolecular arrangement consists of two-dimensional planar networks based on hydrogen bonding among adjacent molecules whereas the latter relies on columnar assembly generated through intermolecular van der Waals interactions. Scanning Tunneling Microscopy (STM) at the solid-liquid interface has been corroborated by cyclic voltammetry measurements and assessed by theoretical calculations to gain multiscale insight into the arrangement of the molecule with respect to the basal plane of the surface. The STM analysis allowed the visualization of these assemblies with a sub-nanometer resolution, and cyclic voltammetry measurements provided direct evidence of the interactions of porphyrin and ferrocene with the graphite surface and offered also insight into the dynamics within the face-on and edge-on assemblies. The experimental findings were supported by theoretical calculations to shed light on the electronic and other physical properties of both assemblies. The capability to engineer the functional nanopatterns through self-assembly of porphyrins containing ferrocene units is a key step toward the bottom-up construction of multifunctional molecular nanostructures and nanodevices.

Assessment, validation and deployment strategy of a two-barcode protocol for facile genotyping of duckweed species

Lemnaceae, commonly called duckweeds, comprise a diverse group of floating aquatic plants that have previously been classified into 37 species based on morphological and physiological criteria. In addition to their unique evolutionary position among angiosperms and their applications in biomonitoring, the potential of duckweeds as a novel sustainable crop for fuel and feed has recently increased interest in the study of their biodiversity and systematics. However, due to their small size and abbreviated structure, accurate typing of duckweeds based on morphology can be challenging. In the past decade, attempts to employ molecular barcoding techniques for species assignment have produced promising results; however, they have yet to be codified into a simple and quantitative protocol. A study that compiles and compares the barcode sequences within all known species of this family would help to establish the fidelity and limits of this DNA-based approach. In this work, we compared the level of conservation between over 100 strains of duckweed for two intergenic barcode sequences derived from the plastid genome. By using over 300 sequences publicly available in the NCBI database, we determined the utility of each of these two barcodes for duckweed species identification. Through sequencing of these barcodes from additional accessions, 30 of the 37 known species of duckweed could be identified with varying levels of confidence using this approach. From our analyses using this reference dataset, we also confirmed two instances where mis-assignment of species has likely occurred. Potential strategies for further improving the scope of this technology are discussed.

Vibrational heating in single-molecule switches: an energy-dependent density-of-states approach

In recent experiments, it has been shown that the switching rate of single-molecule switches can show a rather complicated dependence on the applied bias voltage. Here, we discuss a minimal model which describes the switching process in terms of inelastic scattering processes of the tunneling electron by specific molecular vibrations. One important point is the introduction of an energy-dependent electronic density of states around the Fermi energy. The influence of different model parameters on the switching rate is studied and we show that the inclusion of a variable density of states allows us to understand the non-monotonic behavior of the switching rate observed in some experiments.

A pre-and-post study of an urban renewal program in a socially disadvantaged neighbourhood in Sydney, Australia

BACKGROUND

Urban renewal programs aim to target both the physical and social environments to improve the social capital, social connectedness, sense of community and economic conditions of residents of the neighbourhoods. We evaluated the impact of an urban renewal program on the health and well-being of residents of a socially disadvantaged community in south-western Sydney, Australia.

METHODS

Pre- and post-urban renewal program surveys were conducted with householders by trained interviewers. The urban renewal program was conducted over 16 months and consisted of internal upgrades (including internal painting; replacement of kitchens, bathrooms and carpets; general maintenance), external upgrades (including property painting; new fencing, carports, letterboxes, concrete driveways, drainage and landscaping), general external maintenance, and social interventions such as community engagement activities, employment initiatives, and building a community meeting place. The questionnaire asked about demographic characteristics, self-reported physical activity, psychological distress, self-rated health, and perceptions of aesthetics, safety and walkability in the neighbourhood. We used the paired chi-square test (McNemars test) to compare paired proportions. A Bonferroni corrected p-value of <0.0013 denoted statistical significance.

RESULTS

Following the urban renewal program we did not find statistically significant changes in perceptions of aesthetics, safety and walkability in the neighbourhood. However, post-urban renewal, more householders reported there were attractive buildings and homes in their neighbourhood (18% vs 64%), felt that they belonged to the neighbourhood (48% vs 70%), that their area had a reputation for being a safe place (8% vs 27%), that they felt safe walking down their street after dark (52% vs 85%), and that people who came to live in the neighbourhood would be more likely to stay rather than move elsewhere (13% vs 54%). Changes in psychological distress and self-rated health were not statistically significant.

CONCLUSIONS

We found an increase, in the short-term, in the proportion of householders reporting improvements in some aspects of their immediate neighbourhood following the urban renewal program. It will be important to repeat the survey in the future to determine whether these positive changes are sustained.

Assessing red deer antler density with a hydrostatic method versus a new parametric volume-modelling technique using 3D-CAD

Two methods of volume measurement were compared, to develop a simple and reliable method for estimating the whole-antler density. We used 10 cast antlers, previously dried and weighed, from 10 different red deer (Cervus elaphus hispanicus) individuals. The volumes were determined by the traditional Archimedes method versus a new parametric volume-modelling technique using a ‘computer-aided design-three dimensions’ (3D-CAD), which is now being used in the biomedical industry in applications such as medical-implant design, tissue engineering and in developing a better understanding of anatomical functionality and morphological analysis. The process paths to follow in the generation of CAD models from cast antlers were described. The whole-antler density was estimated from the weight and volume measurement and a paired-sample comparison procedure was performed to assess differences between volumes as well as densities. Cast-antler weight ranged from 219.93 to 1857.9 g, and the volume estimated by the hydrostatic method was 732.45 ± 474.06 cm3 and by the CAD-3D method it was 730.65 ± 492.59 cm3. The DM density of the antler by the hydrostatic method (Density A) was 1.112 ± 0.120 g/cm3, ranging from 0.915 to 1.345 g/cm3 (Shapiro–Wilks, P = 0.449), and by the 3D-CAD method (Density B) it was 1.112 ± 0.158 g/cm3, ranging from 0.939 to 1.326 g/cm3 (Shapiro–Wilks, P = 0.751). There were no differences in the volume (t = 0.95, P = 0.37) or density (t = 0.54, P = 0.60) between the two methods and the correlation coefficient between Density A and Density B was 0.968. Both methods had similar reliability, although the computing process with the 3D-CAD system calculated antler volume faster than did the traditional hydrostatic weighing. 3D-CAD also avoided cast damage and the methodological problems with larger or smaller antlers or with floatability due to low density, which occur when using the hydrostatic method.

GraphClust: A Method for Clustering Database of Graphs

Any application that represents data as sets of graphs may benefit from the discovery of relationships among those graphs. To do this in an unsupervised fashion requires the ability to find graphs that are similar to one another. That is the purpose of GraphClust. The GraphClust algorithm proceeds in three phases, often building on other tools:

(1) it finds highly connected substructures in each graph;

(2) it uses those substructures to represent each graph as a feature vector; and

(3) it clusters these feature vectors using a standard distance measure. We validate the cluster quality by using the Silhouette method. In addition to clustering graphs, GraphClust uses SVD decomposition to find frequently co-occurring connected substructures. The main novelty of GraphClust compared to previous methods is that it is application-independent and scalable to many large graphs.

Policies and management of overabundant deer (native or exotic) in protected areas

A workshop was convened in Chile in August 2010 as part of the 7th International Deer Biology Congress (IDBC). Its aim was to explore global differences in the policies and management of overabundant deer in protected areas. The main goal of the workshop was to provide South American researchers and managers with a snapshot of some of the approaches to management of deer overabundance used in a diverse array of case studies from North America, Europe, Australia and New Zealand. Various case studies were presented to illustrate the different methodological approaches in implementing deer control measures. Some general recommendations were formulated.

MRI Detection of Otherwise Occult Malignancies in Women Recently Diagnosed with Breast Cancer

Objective. Breast Magnetic Resonance Imaging (MRI) is recommended as a screening test for women at high risk for breast cancer but its role as a diagnostic tool for women recently diagnosed with breast cancer is not universally accepted. We report outcomes in a center that routinely uses breast MRI to evaluate extent of disease in patients recently diagnosed with breast cancer.Material and Methods. Between 1/1/2003 and 4/30/2007, 592 patients with recently diagnosed breast cancer underwent bilateral breast MRI to assess extent of disease. All had undergone mammography prior to breast MRI. Twenty-two were excluded because they were either lost to follow up (n=7) or had a mastectomy or lumpectomy (n=15) where correlation of pathology to the study lesion was not possible or incomplete. 570 patients comprised the analysis set. Patient age, index tumor characteristics (histologic subtype, grade, ER/PR status, HER2 status and presence of angiolymphatic invasion), axillary lymph node status, and pathologic stage were recorded in addition to mammographic breast density. All MR exams were coded following the American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) breast MRI lexicon. Biopsy rates, positive predictive values of biopsy, and overall yield of detecting an occult cancer in the ipsilateral or contralateral breast were calculated and compared using Chi-square test across patient age, mammographic breast density, index tumor type, receptor status and presence or absence of lymph node metastases.Results. The distribution of tumor histologies was typical of that seen in the U.S. during the study period, with 61% having invasive ductal index cancers, 21% pure ductal carcinoma in situ, 19% invasive lobular or other invasive cancers and 67% being node negative at time of diagnosis. Additional biopsy was recommended for 152/570 (27%) patients found to have one or more suspicious lesions on MRI distinct from the index cancer, based upon mammographic, sonographic, or clinical exam measurements. Of the 152 women who underwent biopsy, 67 women had additional cancers diagnosed, for a positive predictive value of 44% (67/152). Overall, 12% (67/570) of women had otherwise occult cancers diagnosed by MRI alone: 8% of women had additional sites or greater extent of ipsilateral disease and 4% of women had unsuspected contralateral cancer detected by MRI alone. No significant differences were found in the probability of detecting an occult cancer based on patient age, breast density, index tumor characteristics, or lymph node status.Conclusion. The 12% added cancer yield of MRI in detecting additional ipsilateral or contralateral malignancies in a clinical population of women recently diagnosed with breast cancer is significantly higher than the added cancer yield of MRI screening among women at high risk for breast cancer. The positive predictive value of MRI in this clinical setting is also high, with 44% of women who undergo additional tissue sampling being diagnosed with otherwise occult cancer. The probability of finding additional malignancy does not vary significantly with patient age, breast density, or index cancer characteristics.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4017.

Two-year prospective study of major depressive disorder in HIV-infected men

OBJECTIVE

The risks and factors contributing to major depressive episodes in HIV infection remain unclear. This 2-year prospective study compared cumulative rates and predictors of a major depressive episode in HIV-infected (HIV+) men (N=297) and uninfected (HIV-) risk-group controls (N=90).

METHODS

By design participants at entry were without current major depression, substance dependence or major anxiety disorder. Standardized neuromedical, neuropsychological, neuroimaging, life events, and psychiatric assessments (Structured Clinical Interview for DSM III-R) were conducted semi-annually for those with AIDS, and annually for all others.

RESULTS

Lifetime prevalence of major depression or other psychiatric disorder did not differ at baseline between HIV+ men and controls. On a two-year follow-up those with symptomatic HIV disease were significantly more likely to experience a major depressive episode than were asymptomatic HIV+ individuals and HIV-controls (p<0.05). Episodes were as likely to be first onset as recurrent depression. After baseline disease stage and medical variables associated with HIV infection were controlled, a lifetime history of major depression, or of lifetime psychiatric comorbidity (two or more psychiatric disorders), predicted subsequent major depressive episode (p<0.05). Neither HIV disease progression during follow-up, nor the baseline presence of neurocognitive impairment, clinical brain imaging abnormality, or marked life adversity predicted a later major depressive episode.

LIMITATIONS

Research cohort of men examined before era of widespread use of advanced anti-HIV therapies.

CONCLUSIONS

Symptomatic HIV disease, but not HIV infection itself, increases intermediate-term risk of major depression. Prior psychiatric history most strongly predicted future vulnerability.

Dopamine levels modulate the updating of tastant values

To survive, animals must constantly update the internal value of stimuli they encounter; a process referred to as incentive learning. Although there have been many studies investigating whether dopamine is necessary for reward, or for the association between stimuli and actions with rewards, less is known about the role of dopamine in the updating of the internal value of stimuli per se. We used a single-bottle forced-choice task to investigate the role of dopamine in learning the value of tastants. We show that dopamine transporter knock-out mice (DAT-KO), which have constitutively elevated dopamine levels, develop a more positive bias towards a hedonically positive tastant (sucrose 400 mM) than their wild-type littermates. Furthermore, when compared to wild-type littermates, DAT-KO mice develop a less negative bias towards a hedonically negative tastant (quinine HCl 10 mM). Importantly, these effects develop with training, because at the onset of training DAT-KO and wild-type mice display similar biases towards sucrose and quinine. These data suggest that dopamine levels can modulate the updating of tastant values, a finding with implications for understanding sensory-specific motivation and reward seeking.