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A novel multicomponent alloy, V2.5Cr1.2WMoCo0.04, produced from elements expected to favour a BCC crystal structure, and to be suitable for high temperature environments, was fabricated by arc melting and found to exhibit a multiphase dendritic microstructure with W-rich dendrites and V–Cr segregated to the inter-dendritic cores. The as-cast alloy displayed an apparent single-phase XRD pattern. Following heat treatment at 1187 °C for 500 h the alloy transformed into three different distinct phases - BCC, orthorhombic, and tetragonal in crystal structure. This attests to the BCC crystal structure observed in the as-cast state being metastable. The radiation damage response was investigated through room temperature 5 MeV Au+ ion irradiation studies. Metastable as-cast V2.5Cr1.2WMoCo0.04 shows good resistance to radiation induced damage up to 40 displacements per atom (dpa). 96 wt% of the as-cast single-phase BCC crystal structure remained intact, as exhibited by grazing incidence X-ray diffraction (GI-XRD) patterns, whilst the remainder of the alloy transformed into an additional BCC crystal structure with a similar lattice parameter. The exceptional phase stability seen here is attributed to a combination of self-healing processes and the BCC structure, rather than a high configurational entropy, as has been suggested for some of these multicomponent “High Entropy Alloy” types. The importance of the stability of metastable high entropy alloy phases for behaviour under irradiation is for the first time highlighted and the findings thus challenge the current understanding of phase stability after irradiation of systems like the HEAs.

Purpose: To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods: A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results: Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3–19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions: Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed. © 2017, Springer-Verlag Berlin Heidelberg and ESICM.

Adjuvant therapy is an important component in the management of breast cancer. Receipt of indicated adjuvant chemotherapy, radiation, and hormonal therapy significantly reduces disease recurrence and improves survival among women with early-stage breast cancer (Clarke et al. 2005; Early Breast Cancer Trialists’ Collaborative Group 2005). The National Institutes of Health (NIH) and a number of other leading medical organizations have developed evidence-based guidelines and recommendations regarding the use of adjuvant therapy for breast cancer (Eifel et al. 2001; National Comprehensive Cancer Network 2014). Despite the documented health benefits and recommendations, receipt of adjuvant therapy varies by several nonclinical factors such as race, health insurance, socioeconomic status (SES), and treatment facility characteristics (Griggs et al. 2007; Byers et al. 2008; Wu et al. 2008, 2012; Bhargava and Du 2009; Buist et al. 2009; Yen et al. 2010; Freedman et al. 2011). For example, black women have been shown to be less likely to receive adjuvant chemotherapy (Bhargava and Du 2009; Freedman et al. 2011) and hormonal therapy (Freedman et al. 2011). Compared with private insurance, having Medicaid insurance has been shown to be associated with lower rates of guideline-concordant chemotherapy (Wu et al. 2012). SES has been shown to be associated with breast cancer treatment patterns (Griggs et al. 2007; Byers et al. 2008; Wu et al. 2012), with patients of lower SES experiencing reduced rates of guideline-concordant chemo- and hormonal therapy (Wu et al. 2012). Receipt of adjuvant therapy may depend on treatment facility characteristics, with higher rates of guideline-concordance reported at American College of Surgeons’ Commission on Cancer (CoC)-approved cancer centers (Wu et al. 2012). Increasing age is inversely associated with adjuvant therapy use (Buist et al. 2009; Yen et al. 2010). Although previous studies have provided insight into the factors potentially influencing receipt of adjuvant therapy, little is known about the delivery of adjuvant therapy in nonmetropolitan settings. Rural breast cancer patients may be less likely to receive new treatments due to slower adoption of new technologies in rural locations. Rural patients may also face additional barriers to treatment, such as a lack of experienced providers, lack of technological support, and longer travel distances (Arrington et al. 2013). The present study examines the delivery of adjuvant therapy for breast cancer in the largely rural region of southwest Georgia (SWGA). Specifically, we examine the factors associated with receiving guideline-concordant (1) adjuvant chemotherapy, (2) adjuvant radiation therapy, and (3) adjuvant hormonal therapy, considered both individually and for all adjuvant therapies jointly, among SWGA breast cancer patients. This study presents an innovative approach to constructing a summary measure of “guideline-concordance” when there are multiple possible treatment components (here, different types of adjuvant therapy following breast cancer surgery) and the recommended treatment package for a patient is conditional on her particular clinical circumstances. Whether a patient is guideline-concordant, so defined, becomes an important indicator of the quality of cancer care. Because the summary measure is a two-level (Yes/No) variable, the patient- and provider-level determinants of variations in guideline-concordance can thus be investigated directly through binary logistic regression. In addition, this study examines guideline-concordance in breast cancer treatment within an important and relatively understudied segment of the U.S. population.

This concise text delivers a basic introduction to neurology and is designed for use by medical students during their rotation in neurology and related disciplines. Updated and expanded, this second edition follows the same order as the first, starting with how to approach a patient with a neurologic problem followed by the latest information on the phenomenology, pathophysiology and symptoms of common adult and pediatric neurologic diseases. Supplementing the learning experience are clinical cases that begin each chapter and videos of examples ranging from how to perform the normal neurologic exam to abnormal exam findings. Easy-to-read and richly illustrated, Fundamentals of Neurologic Disease, 2nd Edition is an invaluable resource for anyone seeking to learn the fundamentals of neurology.

Shade from athletic stadium structures can be a significant detriment to turfgrass performance. The objective of this study was to determine the effects of shade on rooting and playing surface stability, measured as traction, on overseeded or non-overseeded bermudagrass (Cynodon spp.) turf. An experiment was established in 2013 on a mature bermudagrass [Cynodon dactylon (L.) Pers. cv. Riviera] turf that was either overseeded with perennial ryegrass (Lolium perenne L.) or non-overseeded. Shade structures were installed to create four light level treatments, including 0%, 30%, 60%, or 90% light-reducing shade cloth. The light treatments resulted in average daily light integrals (DLI) of 40.8, 26.2, 14.8, and 3.3 mol m–2 d–1, respectively. Data were collected on rooting characteristics, species composition, and two forms of traction measurements. Moderate levels of shading (30%) caused a significant decline in rooting characteristics in non-overseeded turf, while rooting of overseeded turf was not significantly affected until a 60% light reduction. Rotational resistance and peak horizontal force, measurements of athlete traction, were affected by increasing shade in both overseeded and non-overseeded turf, but the association between traction and a minimum DLI was not conclusive. The persistence of bermudagrass in overseeded turf was significantly reduced at all shade levels studied. This study clearly demonstrates that rooting, bermudagrass persistence and traction of overseeded and non-overseeded bermudagrass athletic fields are negatively affected by even modest levels of shade.

Shade from athletic stadium structures can be a significant deterrent to turfgrass performance. The objective of this study was to determine the daily light requirements of an overseeded or non-overseeded bermudagrass (Cynodon spp.) turf maintained to simulate an athletic field. An experiment was established in 2013 on a mature bermudagrass [Cynodon dactylon (L.) Pers. cv. Riviera] turf that was either overseeded with perennial ryegrass (Lolium perenne L.) or non-overseeded. Plots were re-seeded with ryegrass each fall, but ryegrass was allowed to transition without chemical removal. Shade structures were installed to create four light level treatments including a full-sun control (0% shade) and 30%, 60%, or 90% light-reducing shade cloth. Quantum light sensors were mounted under each shade treatment and photosynthetic photon flux density (PPFD) was continuously measured and a daily light integral (DLI) calculated (mol PPFD m–2 d–1). The 2-yr, average DLI values for shade treatments were 40.8 (0% shade), 26.2 (30% shade), 14.8 (60% shade) and 3.3 (90% shade) mol PPFD m–2 d–1. A range of growth and performance data were collected, including turfgrass coverage, clipping yields and leaf elongation rates. Overseeded and non-overseeded bermudagrass failed to persist when 90% shade (DLI = 3.0 mol m–2 d–1) was imposed. Non-overseeded bermudagrass required a higher DLI (26 mol m–2 d–1) to persist compared to overseeded bermudagrass (DLI = 21.8 mol m–2 d–1), primarily due to the enhanced shade tolerance of perennial ryegrass. However, the long-term effects of shade began to decrease the quality of the overseeded turf by the end of the second year of the study. These data provide sports field managers with threshold light requirements for both overseeded and non-overseeded bermudagrass turf.