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Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend adjuvant chemotherapy (AC) within 6–8 weeks of surgical resection for patients with stage III colon cancer. However, postoperative complications or prolonged surgical recovery may affect the receipt of AC. The aim of this study was to assess the utility of AC for patients with prolonged postoperative recovery. Methods: We queried the National Cancer Database (2010–2018) for patients with resected stage III colon cancer. Patients were categorized as having either normal or prolonged length of stay (PLOS: >7 days, 75th percentile). Multivariable Cox proportional hazard regression and logistic regressions were used to identify factors associated with overall survival and receipt of AC. Results: Of the 113,387 patients included, 30,196 (26.6%) experienced PLOS. Of the 88,115 (77.7%) patients who received AC, 22,707 (25.8%) initiated AC more than 8 weeks after surgery. Patients with PLOS were less likely to receive AC (71.5% vs. 80.0%, OR: 0.72, 95%CI=0.70–0.75) and displayed inferior survival (75 vs. 116 months, HR: 1.39, 95%CI=1.36–1.43). Receipt of AC was also associated with patient factors such as high socioeconomic status, private insurance, and White race (p<0.05 for all). AC within and after 8 weeks of surgery was associated with improved survival for patients with both normal LOS and PLOS (normal LOS: <8 weeks HR: 0.56, 95% CI: 0.54–0.59, >8 weeks HR: 0.68, 95% CI: 0.65–0.71; PLOS: <8 weeks HR: 0.51, 95% CI: 0.48–0.54, >8 weeks HR: 0.63, 95% CI 0.60–0.67). AC was associated with significantly improved survival if initiated up to 15 weeks postoperatively (normal LOS: HR: 0.72, 95%CI=0.61–0.85; PLOS: HR: 0.75, 95%CI=0.62–0.90), and very few patients (<3.0%) initiated AC beyond this time. Conclusion: Receipt of AC for stage III colon cancer may be affected by surgical complications or otherwise prolonged recovery. Timely and even delayed AC (>8 weeks) are both associated with improved overall survival. These findings highlight the importance of delivering guideline-based systemic therapies, even after complicated surgical recovery. [ABSTRACT FROM AUTHOR]

• Early signs of an R&D turnaround: Phase II success rates improved from 19% to 53%. • Sharp therapeutic area focus deepened our understanding of biology and drug targets. • Selectively diversifying modalities expanded the range of eligible drug targets. • Portfolio governance strengthened through more systematic quantitative metrics. The pharmaceutical industry has faced declining research and development (R&D) productivity for decades. During the early 2010s, Pfizer saw its R&D productivity drop even more sharply than did its industry peers. As impactful medicines the company had developed and brought to patients in previous years lost exclusivity, Pfizer faced a steep patent cliff with a cumulative revenue impact of >US$28 billion through 2018. Since 2010, the company has embarked on a focused turnaround effort to improve R&D productivity. Although some efforts will need more time to prove themselves, there are early signs of a turnaround now, particularly in terms of Phase II success rates. Here, we share some learnings from a decade of experience as one of the largest R&D organizations in the industry. [ABSTRACT FROM AUTHOR]

• Current methods for ubiquitination studies are time consuming and labor intensive. • Sandwich immunoassay with electro-chemiluminescent detection is a novel approach to ubiquitination studies. • The developed method can quantitate total and ubiqutinated Diablo. • The method can be used to distinguish signaling events mediated by intracellular ubiquitination. Ubiquitin plays an essential role in modulating protein function, and deregulation of the ubiquitin system leads to the development of a variety of human diseases. E3 Ubiquitin ligases that mediate ubiquitination and degradation of caspases prevent apoptosis, and as such belong to the family of inhibitors of apoptosis proteins (IAPs). Diablo is a substrate of IAPs but also a negative regulator of IAPs in apoptotic pathway as it blocks the interaction between IAPs and caspases. In efforts to identify IAP inhibitors, we developed sandwich immunoassays in conjunction with an electrochemical luminescence (ECL) platform for quantitation of total Diablo, ubiquitinated Diablo, and ubiquitinated Diablo with K48-specific linkage. The assay panel detects Diablo ubiquitination level changes in the presence of IAP inhibitor or proteasome inhibitor, demonstrating its potential as a cost-efficient high-throughput method for drug discovery involving IAP ubiquitination cascade. The ECL based sandwich assay panel performance was subsequently evaluated for precision, linearity, and limit of quantification. [ABSTRACT FROM AUTHOR]

Objectives Clostridium innocuum can cause extraintestinal infection in patients with underlying diseases. The role of C. innocuum in antibiotic-associated diarrhoea (AAD) remains unknown. Methods Clinical information of 103 patients from whom C. innocuum was isolated was reviewed. We carried out cellular and animal experiments to examine the pathogenic potential of C. innocuum in AAD. Results Eighty-eight per cent (91/103) of the 103 patients received antibiotics within 2 weeks of diarrhoea onset. Patients were further classified into two groups, severe colitis and diarrhoea, according to clinical severity level. The mortality rate was 13.6% (14/103) among the patients from whom C. innocuum was isolated. The lowest concentrations at which 90% of the isolates were inhibited for metronidazole and vancomycin were 0.5 and 16 mg/L, respectively. All isolates tested were susceptible to metronidazole but resistant to vancomycin. Nineteen randomly selected isolates (ten from severe colitis group, nine from diarrhoea group) were subjected to further in vitro cellular examinations. The level of cytotoxicity to Vero cells was significantly higher in isolates from the severe colitis group at both 24 and 48 hours after inoculation (24 and 48 hours, p 0.042 and 0.033, respectively). We observed apoptotic changes that subsequently led to cell death in C. innocuum –infected Vero cells. Tissue damages, necrotic changes and oedema were observed in the mouse ileal loop infected by C. innocuum. Conclusions Vancomycin-resistant C. innocuum may play a potential role as a causative agent of AAD. The clinical manifestations of AAD caused by C. innocuum were diarrhoea or severe colitis, including pseudomembranous colitis. [ABSTRACT FROM AUTHOR]

The evaluation of simple thermal model of selective laser melting (SLM) process shows that the temperature distribution in the sample is characterized by two dimensionless parameters: normalized enthalpy and the ratio of dwell time to the thermal diffusion time. We demonstrated that the melt depth data taken for different machines for different materials collapsed in one curve, making possible to rescale the optimal processing parameters between the different materials and machines. The melt pool depth, width and the length are the universal function of these two parameters. Within the operational range of parameters for SLM these functions can be interpolated by the simple algebraic expressions given the possibility to reduce the calculation of the melt pool characteristic to spreadsheet model. [ABSTRACT FROM AUTHOR]

We present a self-adaptive genetic algorithm for the problem of predicting if a Medicare standardized payment to a physical therapist will be above or below the national median. The percentage of Americans 65 and over is expected to increase in the coming years, increasing the need for physical therapy services. As a result, accurate prediction of expected Medicare payments based on local factors will be of increasing importance. A self-adaptive genetic algorithm is an evolutionary algorithm in which some or all of the algorithm's parameters are evolved over the course of its execution. Self-adaptation is a useful tool both for improving the performance of evolutionary algorithms, as well as improving usability through lessening the amount of parameter tuning required of the algorithm's user. While other self-adaptive approaches tend to focus on self-adaptation of only a few parameters, our approach self-adapts all of the parameters related to crossover and mutation. We compare the performance of our self-adaptive genetic algorithm with that of logistic regression and a canonical genetic algorithm on the problem of predicting Medicare payments. Logistic regression is a commonly used benchmark for this type of problem and a canonical genetic algorithm is included to allow us to see if any performance costs arise from the self-adaptive mechanisms. Results show that our self-adaptive genetic algorithm is effective at the classification of Medicare standardized payments to physical therapists, achieving accuracies of over 93%. Performance remains strong with training sets as small as 5% of the full data set. The problem representation used by our method allows for the identification of the relevant features for classification which means that our approach is capable of simultaneously performing classification and feature selection. • Self adaptation eases the burden of parameter tuning for a genetic algorithm. • Classification of expected Medicare payments based on provider features. • Identification of relevant features for effective classification. • Performance comparable to a canonical genetic algorithm and logistic regression. [ABSTRACT FROM AUTHOR]

Coiled-Coil Domain Containing 47 (CCDC47) is an endoplasmic reticulum (ER) transmembrane protein involved in calcium signaling through utilization of its calcium binding-acidic luminal domain. CCDC47 also interacts with ERAD (endoplasmic reticulum-associated degradation) complex and is involved in ER stress relief. In this report, we developed human CCDC47 monoclonal antibodies and a sandwich immunoassay for CCDC47 measurement in biological matrices. Specificity of developed antibodies were confirmed by immunoblot and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of immunoprecipitated cell lysates. To achieve high analytical sensitivity, traditional colorimetric enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence (ECL) technology were compared, and 3 logs of increased sensitivity was observed with the use of ECL. A CCDC47 sandwich ECL assay was subsequently developed and performances evaluated for calibration curves, precision and accuracy, as well as selectivity and interferences for sample measurement. Sample stability was also characterized for freeze/thaw cycles and short/long term storage conditions. [ABSTRACT FROM AUTHOR]

Residual stresses induced in the layer-by-layer fabrication process of additively manufactured parts have significant impact on their mechanical properties and dimensional accuracy. This work aims to characterize the residual stress and deformation in specimens based on unreinforced acrylonitrile-butadiene-styrene (ABS), carbon nanotube reinforced ABS and short carbon fiber reinforced ABS. The shrinkage and displacement fields were obtained, respectively, by thermal treatment as well as Digital Image Correlation observation of specimens before and after sectioning. The microstructure and porosity of additively manufactured specimens were also examined using X-ray micro-computed tomography. Specimen shrinkage and porosity content were significantly influenced by the process parameters of raster angle and printing speed, as well as material types. Faster printing speed led to larger porosity and residual stress, as well as higher shrinkage after specimen thermal treatment. Raster angle had a greater influence on specimen shrinkage and porosity as comparing to printing speed. Composite printing wires based on carbon nanotube and short carbon fiber in ABS greatly reduced specimen shrinkage and deformation, while increased the porosity, especially for carbon fiber reinforced ABS specimens. [ABSTRACT FROM AUTHOR]

Individual differences in children's math performance have been associated with math anxiety, attention problems, working memory (WM), and reading skills, but the mechanisms by which these factors jointly contribute to children's math achievement are unknown. Here, we use structural equation modeling to characterize the relation between these factors and their influence on non-verbal Numerical Operations (NO) and verbal Math Reasoning (MR) in 330 children (M=8.34years). Our findings indicate that WM plays a central role in both non-verbal NO and verbal MR, whereas math anxiety and reading comprehension have unique and more pronounced influences on MR, compared to NO. Our study elucidates how affective and cognitive factors distinctly influence non-verbal and verbal mathematical problem solving. [ABSTRACT FROM AUTHOR]

This study aimed to systematically review the literature to determine outcomes following surgical treatment of pediatric vocal fold nodules. Studies with patients ≤18 years with nodules who underwent surgery were reviewed for dysphonia improvement and recurrence in PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science databases, searched from inception to November 1, 2022 using PRISMA guidelines. Non-English studies and case reports were excluded. Two evaluators independently reviewed each abstract and article. Heterogeneity and bias across studies were evaluated and meta-analysis was performed. The literature search yielded 655 articles; 145 underwent full-text screening and eight were selected for systematic review and meta-analysis. There were 311 children with nodules, aged 2–18 years, with male-to-female ratio of 3.6:1. There were no surgical complications. Voice therapy was inconsistently reported. Follow-up time ranged from 1 month to 10 years. One study concluded that neither surgery nor voice therapy was effective, while five studies concluded that dysphonia improved with surgery. Voice grading by GRBAS, objective voice measures, and lesion size were improved following surgery, when reported. Meta-analysis of six studies demonstrated improvement in dysphonia in 90% of children post-operatively (95% CI: 74–99%). Meta-analysis of four studies showed that recurrence occurred in 19% of children (95% CI: 13–23%). This systematic review suggests possible post-operative improvement in dysphonia for pediatric patients with vocal fold nodules; however, study measures, methods, and surgery utilized were heterogeneous and results should be interpreted cautiously. In order to better understand surgical outcomes, future studies should include standardized definition of nodules and objective measures of voice. [ABSTRACT FROM AUTHOR]

Uranium-niobium alloys can exist with significantly different microstructures and mechanical properties, heavily influenced by thermomechanical processing history and impurities. Here, the influence of Ti and other impurities is studied on uranium-14 at.% niobium additively manufactured using laser powder bed fusion. Two different metallic impurity levels were investigated and a Nb equivalent (Nb eq ) composition is defined to represent the impurities. In-situ neutron diffraction during compression loading shows that increased Nb eq promotes the formation of γ°-tetragonal phase at the expense of α″-monoclinic phase, resulting in 2 × higher yield strength than water quenched α″ and a strain induced transformation to α″ with superelastic strains to 4.5%. [ABSTRACT FROM AUTHOR]

Objective We sought to understand the alteration in the anisotropic, or direction dependent, character of muscle as measured by electrical impedance myography (EIM) in subjects with Duchenne muscular dystrophy (DMD) and its potential to serve as a biomarker of disease status. Methods Thirty-six boys with DMD and 27 healthy controls were measured with EIM, with electrical current applied both parallel and perpendicular to the major muscle fiber direction. In addition, muscle extracted from 10 mdx and 10 wild-type mice were measured analogously. Results Normalized reactance anisotropy, a direction-dependent measure of membrane charge storage capability, was significantly lower in the four muscles of DMD subjects as compared to controls ( p < 0.01). Normalized reactance anisotropy also decreased with increasing age in DMD subjects ( r = −0.36, p = 0.031), but not in healthy boys. Analogous changes were observed in mdx mouse gastrocnemius as compared to wild type ( p = 0.019). Conclusion These results support that loss of electrical anisotropy is a previously unrecognized feature of dystrophic muscle. Significance Anisotropic alterations may offer novel indices to assist in neuromuscular disease diagnosis and to serve as easy-to-obtain biomarkers in clinical therapeutic trials. [ABSTRACT FROM AUTHOR]

Background: Although anxiety sensitivity (AS) presents in adults with obsessive-compulsive disorder (OCD), it has received minimal empirical attention. There are postulated connections between AS and family accommodation, but this relationship has yet to be formally examined.Methods: The present study included 58 adults with OCD who completed a clinician-rated measure of OCD symptom severity, as well as self-report measures assessing AS, family variables, impairment, and co-occurring psychopathology.Results: Participants' AS moderately correlated with family accommodation, family functioning, and depression, while strongly correlating with anxiety symptoms. The Fear of Cognitive Dyscontrol AS subscale moderately correlated with multiple domains of functional impairment, and predicted family accommodation beyond the effects of OCD symptom severity. Family accommodation mediated the relationship between the Fear of Cognitive Dyscontrol AS subscale and functional impairment.Limitations: The study was cross-sectional in nature, limiting the ability to establish directionality and causation. The sample was also limited to adults with OCD and their own symptomology, necessitating further investigations of these constructs in pediatric samples and psychopathology in the caregivers/relatives.Conclusions: These findings highlight the importance of considering fears regarding the loss of mental control within the context of family accommodation in OCD when evaluating functional impairment. [ABSTRACT FROM AUTHOR]

The article presents a study which focused on the prevalence of influenza in Beijing and explored the relationship between socio-economic status indicators and the preventive measures for influenza.

• Deformation mechanism maps are constructed to assess the plastic deformation. • HCP to FCC phase transformation occurs due to the athermal dislocation cross-slip. • Solid-state amorphization at grain boundaries leads to high damage tolerance. • Design guidelines for Cantor alloys at cryogenic temperatures are proposed. High-entropy alloys deform plastically and may also be at risk to fracture in extreme environments. In this paper, the damage tolerance of nanocrystalline Cantor alloys under mode I loading at cryogenic temperatures is investigated via molecular dynamics. We find that the damage tolerance is improved significantly with the decrease of temperature, in contrast to conventional metals. Deformation mechanism maps are constructed to assess the plasticity based on the grain size and temperature. Results show that the plastic deformation is governed by a synergy of face-centered-cubic to hexagonal closed-packed martensite transformation, twinning, stacking fault formation, grain boundary (GB) plasticity, and especially dynamic recovery. Specifically, a crossover from shear localization to solid-state amorphization is identified with the decrease of temperature and grain size. The amorphization at GBs dissipates larger strain energy, leading to precursor retardation and hence a high damage tolerance. A final deformation mechanism map is constructed to combine the deformation mechanisms and the crossover pathway from localization to amorphization. This map has great implications on improving the damage tolerance of Cantor alloy at cryogenic temperatures. Graphical Abstract [Display omitted]. [ABSTRACT FROM AUTHOR]

Family accommodation in obsessive–compulsive disorder (OCD) is characterized by myriad behaviors, such as modifying family routines, facilitating avoidance, and engaging in compulsions to reduce obsessional distress. It has been linked to various deleterious outcomes including increased functional impairment and poorer treatment response for OCD. Although extant literature suggests a linear relationship between family accommodation and OCD symptom severity, the magnitude and statistical significance of this association has been inconsistent across studies, indicating that moderators may be influencing this relationship. The present study examined this relationship using meta-analytic techniques, and investigated sample-dependent (age, gender, comorbid anxiety/mood disorders) and methodological (administration method and number of items used in family accommodation measure, informant type, sample size, publication year) moderators. Forty-one studies were included in the present meta-analysis, and the overall effect size (ES) for the correlation between family accommodation and OCD symptom severity was moderate ( r = .42). Moderator analyses revealed that the number of items on the family accommodation scale moderated the ES. No other sample-dependent or methodological characteristics emerged as moderators. In addition to being the first systematic examination of family accommodation moderators, these results highlight the moderate relationship between family accommodation and OCD severity that is influenced by measurement scales. Findings may be used to guide clinical care and inform future investigations by providing a more nuanced understanding of family accommodation in OCD. [ABSTRACT FROM AUTHOR]

Through observing the marker material (MM) distribution and the exit holes left by the "tool sudden stop action" technique, the formation mechanism of tunnel defect in friction stir welding (FSW) is elucidated. Based on the MM distribution on the transverse cross-sections, the weld nugget zone is divided into three subzones, i.e., shoulder affected zone (SAZ), pin affected zone (PAZ), and weld bottom zone (WBZ). There is a time-delay feature of material flow which is considered as the inducement of tunnel defect formation. When a tunnel defect occurs in FSW joints, three subzones connect with each other and there exists a converging point. The insufficient material flow from retreating side to advancing side in the PAZ and the shortage of downward material transfer in the SAZ are the primary and secondary reasons for tunnel defect occurrence, respectively. Under the same welding conditions, ultrasonic vibration enhanced friction stir welding (UVeFSW) can eliminate the tunnel defect in the weld nugget zone where the SAZ and WBZ are separated by the PAZ, because the exerted ultrasonic vibration improves the material flow in the PAZ and reduces or even suppresses the time-delay of material flow in the PAZ. [ABSTRACT FROM AUTHOR]

A process was proposed for upgrading heavy oil using non-thermal plasma technology in a conventional thermal cracking system under atmospheric pressure. Results from a comparison of the reactivity of a N 2 , H 2 and CH 4 plasma showed that the plasma can increase the trap oil yield significantly. The trap oil yield increased by ∼9% when the N 2 plasma was applied and showed a further increase of ∼19% when the H 2 or CH 4 plasma was applied. A detailed study on the H 2 plasma-enhanced upgrading process was carried out and the results showed that the trap oil yields of the plasma-on runs can be 8–33% higher than those of the plasma-off runs, depending on experimental conditions. Compared with the plasma-off runs, trap oil from the plasma-on runs had a higher (H/C) atomic but less heteroatoms (S and N). Over-balanced hydrogen in the products from plasma-on runs revealed the H 2 plasma reactivity, which was further demonstrated by an increase in the substitution and condensation indices of trap oil from the plasma-on runs. Although thermal cracking was mainly involved whether the plasma was applied or not, the electrical field for generating the plasma and the generated plasma may assist with hydrocarbon bond cleavage. This was shown by the increased trap oil yield with the N 2 plasma and the hydrogen and carbon residue distribution. Compared with the feedstock, more aromatic and γ-hydrogen (H A and H γ , respectively) and less α- and β-hydrogen (H α and H β , respectively) were present in the residues, which agrees with the bond dissociation energy data. Similarly, the amounts of saturated (C s ) and alkyl (C p ) carbons in the residues were significantly lower than those in the feedstock while the amount of aromatic carbons (C a ) in the residues was higher than the feedstock. The changes in hydrogen and carbon distribution were more significant for the plasma-on runs. This implies that mainly side chain losses and bridged bond breakage are involved in the processes. This was demonstrated further by the molecular weight distribution. In general, the molecular weight of the residues was lower than that of the feedstock, especially for residues from the plasma-on runs. However, compared with the feedstock, the residues contained less saturated, aromatic and resin fractions but more asphaltene and toluene insoluble fractions. This implies that intra-molecular condensation was more significant than inter-molecular condensation, especially in the plasma-on runs. This should be attributed to the higher stabilization ability of the H 2 plasma for fragments or radicals and gas (plasma) flow by which the fragments or radicals are separated rapidly. [ABSTRACT FROM AUTHOR]

Background The use of ultrasound during invasive bedside procedures is quickly becoming the standard of care. Ultrasound machine placement during procedures often requires the practitioner to turn their head during the procedure to view the screen. Such turning has been implicated in unintentional hand movements in novices. Google Glass is a head-mounted computer with a specialized screen capable of projecting images and video into the view of the wearer. Such technology may help decrease unintentional hand movements. Objective Our aim was to evaluate whether or not medical practitioners at various levels of training could use Google Glass to perform an ultrasound-guided procedure, and to explore potential advantages of this technology. Methods Forty participants of varying training levels were randomized into two groups. One group used Google Glass to perform an ultrasound-guided central line. The other group used traditional ultrasound during the procedure. Video recordings of eye and hand movements were analyzed. Results All participants from both groups were able to complete the procedure without difficulty. Google Glass wearers took longer to perform the procedure at all training levels (medical student year 1 [MS1]: 193 s vs. 77 s, p > 0.5; MS4: 197s vs. 91s, p ≤ 0.05; postgraduate year 1 [PGY1]: 288s vs. 125 s, p > 0.5; PGY3: 151 s vs. 52 s, p ≤ 0.05), and required more needle redirections (MS1: 4.4 vs. 2.0, p > 0.5; MS4: 4.8 vs. 2.8, p > 0.5; PGY1: 4.4 vs. 2.8, p > 0.5; PGY3: 2.0 vs. 1.0, p > 0.5). Conclusions In this study, it was possible to perform ultrasound-guided procedures with Google Glass. Google Glass wearers, on average, took longer to gain access, and had more needle redirections, but less head movements were noted. [ABSTRACT FROM AUTHOR]

To evaluate apparent diffusion coefficient (ADC) and its standard deviation (SD ADC) in preoperative predicting liver invasion by T3-staged gallbladder carcinoma (GBC). Forty-one consecutive patients with T3-staged resectable GBC were included and divided into two sets with (n= 27) and without (n= 14) liver invasion. All patients underwent DWI at b-values of 0, 20, 50, 80, 100, 200, 400, 600, 800, and 1,000 s/mm2 with a 3 T magnetic resonance imaging scanner before surgery. ADC and SD ADC of tumour-adjacent and tumour-distant liver tissues were measured on DWI, and were compared by Mann–Whitney U -tests. If there was a significant difference in any derived parameter, the area under the receiver operating characteristic curve (AUC) was used to assess performance of this parameter to predict liver invasion. DWI could differentiate between patients with and without liver invasion when b = 0, 1,000 s/mm2 (AUCs of ADC and SD ADC were 0.697 and 0.714, respectively). In patients with liver invasion, mean ADC and SD ADC of tumour-adjacent liver tissue were lower than of tumour-distant liver tissue when b = 0, 800 s/mm2, and = 0, 1,000 s/mm2 (all p -values <0.05). To differentiate tumour-adjacent from tumour-distant liver tissues in patients with liver invasion, AUCs of ADC were 0.687 (b = 0, 800 s/mm2) and 0.680 (b = 0, 1,000 s/mm2), and AUCs of SD ADC were 0.673 (b = 0, 800 s/mm2) and 0.731 (b = 0, 1,000 s/mm2). DWI could have potential value in preoperative predicting liver invasion by T3-staged GBC. • DWI can preoperatively predict liver invasion by T 3 -staged gallbladder carcinoma. • For liver invasion, DWI can help identify tumor-adjacent and -distant liver tissues. • DWI shows no difference between tumor-adjacent and -distant tissues without invasion. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care–seeking for LBP. Purpose: The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. Study design/Setting: The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. Methods: In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. Results: After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing total health care costs. Had the 1,995 soldiers in the PSEP group not received PSEP, we would estimate that 16.7% of them would incur an adjusted median LBP-related health care cost of $517 compared with the current 15.0% soldiers incurring an adjusted median cost of $399, which translates into an actual LBP-related health care cost savings of $52,846 during the POLM trial. However, it is likely that the unaccounted for direct and indirect costs might erase even these small cost savings. Conclusion: The results of this study will help to inform policy- and decision-making regarding the feasibility of implementing psychosocial education in military training environments across the services. It would be interesting to explore in future research whether cost savings from psychosocial education could be enhanced given a more individualized delivery method tailored to an individual's specific psychosocial risk factors. [Copyright &y& Elsevier]

Aim: To determine the incidence of missed femoral head avascular necrosis (AVN) on pelvic computed tomography (CT) performed for clinical indications other than assessment for AVN. Materials and methods: The study was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. The picture archiving and communication system (PACS) database was queried for patients with diagnosis of femoral head AVN on magnetic resonance imaging (MRI), who also underwent pelvic multidetector CT after or <30 days before the MRI examination. The MRI and CT images of 144 hips of 72 patients (39 patients with reported AVN on MRI and 33 age-matched controls; mean age = 60 years, 28 male, 44 female), were reviewed in consensus by two readers in a randomized, blinded manner. Using MRI-proven CT-visible AVN as a reference standard, the incidence of missed AVN on initial CT interpretation was determined. Results: Readers confirmed AVN in 33 patients on the MRI images. Nine hips with AVN underwent joint replacement of the affected joint(s) prior to subsequent CT and were excluded. Forty-three MRI-proven AVN cases in 28 patients (15 bilateral, 13 unilateral) were available for analysis. The study readers diagnosed 35/43 (81%) MRI-proven AVN cases in 22/28 (79%) patients. Four of the 35 (11%) cases of MRI-proven, CT-visible AVN were prospectively reported in 3/22 (14%) patients at initial clinical interpretation, with a miss rate of 89% per hip and 86% per patient. Conclusion: Multidetector CT has high accuracy for detection of AVN; however, this is frequently missed as an incidental finding (89% missed in the present study). Assessment for signs of femoral AVN should be part of routine search pattern in interpretation of pelvic CT. [Copyright &y& Elsevier]

Abstract: Background: Parkinson's disease (PD) patients are hospitalized more frequently than their peers as a result of falls, psychosis, infections and other medical complications. However, patient-specific risk factors for hospitalization are unclear. Objective: To identify rates and risk factors for hospital encounters (Emergency Room [ER] visits or hospitalization) among people with PD. Methods: 3415 PD participants (mean age 67 ± 10 years, disease duration 9 ± 6 years, H&Y 2 47%, H&Y 3 26%) enrolled in the prospective international multicenter NPF-QII Study. One-year follow-up data was available for 1030 patients. Rates and risk factors for hospital encounters were determined at baseline and after one year follow-up. Results: Of 3415 PD participants at study entry, 1120 (33%) reported at least one hospital encounter. Associations were: longer timed up-and-go test (OR: 1.33), increased comorbidities (OR: 1.25), motor fluctuations (OR: 1.32), and deep brain stimulation (DBS) (OR: 2.49). Of these 1120 persons, 311 had follow-up data and 158 (51%) had a repeat encounter one year later, associated with higher H&Y stage, fluctuations, and lower health-related quality-of-life. Of 2295 participants without a hospital encounter at baseline, 719 had follow-up data and 178 (25%) had a first hospital encounter one year later. Risk factors were female gender, comorbidities, lower cognition, fluctuations, and DBS. Conclusions: One-third of people with PD had a hospital encounter each year, and one-half of those had a repeat encounter. These high rates correlated with disease severity, comorbidities and DBS. There is an urgent need to develop programs to reduce PD hospital encounters. [Copyright &y& Elsevier]

BACKGROUND: Our purpose was to determine the relationship between preoperative frailty and the occurrence of postoperative complications after colorectal and cardiac operations. METHODS: Patients 65 years or older undergoing elective colorectal or cardiac surgery were enrolled. Seven baseline frailty traits were measured preoperatively: Katz score less than or equal to 5, Timed Up and Go test greater than or equal to 15 seconds, Charlson Index greater than or equal to 3, anemia less than 35%, Mini-Cog score less than or equal to 3, albumin less than 3.4 g/dL, and 1 or more falls within 6 months. Patients were categorized by the number of positive traits as follows: nonfrail: 0 to 1 traits, prefrail: 2 to 3 traits, and frail: 4 or more traits. RESULTS: Two hundred one subjects (age 74 ± 6 years) were studied. Preoperative frailty was associated with increased postoperative complications after colorectal (nonfrail: 21%, prefrail: 40%, frail: 58%; P = .016) and cardiac operations (nonfrail: 17%, prefrail: 28%, frail: 56%; P <.001). This finding in both groups was independent of advancing age. Frail individuals in both groups had longer hospital stays and higher 30-day readmission rates. Receiver operating characteristic curves examining frailty's ability to forecast complications were colorectal (.702, P = .004) and cardiac (.711, P <.001). CONCLUSIONS: A simple preoperative frailty score defines older adults at higher risk for postoperative complications across surgical specialties. [ABSTRACT FROM AUTHOR]

Abstract: Background context: Many clinical studies have demonstrated the effectiveness of electrical stimulation as an adjunct to spinal arthrodesis. However, there is a paucity of comparative data among different electrical stimulation techniques. Purpose: To compare the efficacy of three electrical stimulation methods for spinal fusion based on the literature review. Sample: Twenty-one articles, meeting all the inclusion criteria, were selected. A total of 1,381 patients were evaluated. Study design: Systematic literature review and meta-analysis. Outcome measures: Fusion rates were determined using radiography or computed tomography. Methods: A systematic literature review was conducted on spinal fusion surgeries with the aid of electrical stimulation devices. Only studies applying radiography or computed tomography for fusion assessment were included. Study groups were divided based on electrical stimulation types and were further grouped by other patient characteristics. Pooled estimates and 95% confidence intervals (CIs) were calculated by random-effects meta-analysis. Results: The pooled fusion rate for all studies was 85% (95% CI, 79–90). There were 14 direct current, 1 capacitive coupling (CC), and 10 inductive coupling studies in our analysis, with combined fusion rate of 85% (95% CI, 76–91), 90% (95% CI, 83–95), and 85% (95% CI, 74–93), respectively. There were no statistically significant differences among the three electrical stimulation methods. Further subgroup analysis suggested that age, sex, smoking status, surgery type, fusion levels, fusion column, implant use, and graft type did not significantly influence the fusion rate. Conclusions: The three types of electrical stimulation devices had similar clinical efficacy in promoting bone growth for spinal fusion. The results for CC stimulation should be applied with caution as only one relevant study was identified. [Copyright &y& Elsevier]

Background: One strategy proposed to alleviate nursing shortages is the promotion of organizational efforts that will improve nurse recruitment and retention. Cross-sectional studies have shown that the quality of the nurse work environment is associated with nurse outcomes related to retention, but there have been very few longitudinal studies undertaken to examine this relationship. Objectives: To demonstrate how rates of burnout, intention to leave, and job dissatisfaction changed in a panel of hospitals over time, and to explore whether these outcomes were associated with changes in nurse work environments. Methods: A retrospective, two-stage panel design was chosen for this study. Survey data collected from large random samples of registered nurses employed in Pennsylvania hospitals in 1999 and 2006 were used to derive hospital-level rates of burnout, intention to leave current position, and job dissatisfaction, and to classify the quality of nurses' work environments at both points in time. A two-period difference model was used to estimate the dependence of changes in rates of nurse burnout, intention to leave, and job dissatisfaction on changes in nurse work environments between 1999 and 2006 in 137 hospitals, accounting for concurrent changes in nurse staffing levels. Results: In general, nurse outcomes improved between 1999 and 2006, with fewer nurses reporting burnout, intention to leave, and job dissatisfaction in 2006 as compared to 1999. Our difference models showed that improvements in work environment had a strong negative association with changes in rates of burnout (β = -6.42%, p < 0.01) intention to leave (β = -4.10%, p < 0.01), and job dissatisfaction (β = -8.00%, p < 0.01). Conclusions: Improvements in nurse work environments over time are associated with lower rates of nurse burnout, intention to leave current position, and job dissatisfaction. [ABSTRACT FROM AUTHOR]

Abstract: With the rise of composite materials as replacements for traditional monolithic materials comes an increase in demand for multifunctionality. Prior studies have demonstrated the ability of an embedded, electrically percolating carbon nanotube network to respond electrically to the onset and progression of damage in composite structures. We build upon this work by incorporating healing functionality into braided composites through the use of a hollow channel resin delivery system. This study demonstrates the ability of a carbon nanotube network to sense crack filling during resin injection, thus providing the scientific basis required for sensing healing in advanced composites. With practical application in mind, a two-part healant system is employed in this study. Two methods for qualitatively assessing healing are employed and compared; these include elastic modulus/strain energy recovery and FTIR spectroscopy. [Copyright &y& Elsevier]

Abstract: This investigation into the rate-dependent tensile behavior of carbon nanotube (CNT) fibers provides insight into the role of strain rate and specimen gage length on tensile strength. Chemical vapor produced CNT continuous fibers made of single and dual wall CNTs are evaluated and the potential for fiber improvement by post-process stretching to improve alignment is explored. Post-processed CNT fibers exhibit significantly higher strengths (3–5GPa) and moduli (80–200GPa) than untreated fibers. During dynamic tension evaluation, real-time electrical measurements provide correlations between high rate deformation/damage mechanical behavior and electrical resistance of the fiber specimens. Furthermore, this first look into the dynamic tensile behavior of CNT fibers demonstrates their potential to serve as sensors in high rate applications. [Copyright &y& Elsevier]

Investigations into carbon nanotube fibers as not only structural reinforcement materials but also standalone or embedded strain/damage, thermal, atmospheric and biochemical sensors are driven by their high specific strength, stiffness, electrical and thermal conductivity, and extreme flexibility. With future applications in view, we have studied their load transfer mechanisms, coupled electrical and mechanical response, high strain rate behavior and adaptability to resin infusion. This article is intended to cover our research over the past couple years and to highlight relevant and interesting work performed by others in the area of carbon nanotube fiber mechanics and experimental characterization. [Copyright &y& Elsevier]

Background: Preoperative risk stratification is commonly performed by assessing end-organ function (such as cardiac and pulmonary) to define postoperative risk. Little is known about impaired preoperative cognition and outcomes. The purpose of this study was to evaluate the impact of baseline impaired cognition on postoperative outcomes in geriatric surgery patients. Study Design: Subjects 65 years and older undergoing a planned elective operation requiring postoperative ICU admission were recruited prospectively. Preoperative baseline cognition was assessed using the validated Mini-Cog test. Impaired cognition was defined as a Mini-Cog score of ≤3. Delirium was assessed using the Confusion Assessment Method-ICU by a trained research team. Adverse outcomes were defined using the Veterans Affairs Surgical Quality Improvement Program definitions. Results: One hundred and eighty-six subjects were included, with a mean age of 73 ± 6 years. Eighty-two subjects (44%) had baseline impaired cognition. The impaired cognition group had the following unadjusted outcomes: increased incidence of 1 or more postoperative complications (41% vs 24%; p = 0.011), higher incidence of delirium (78% vs 37%; p < 0.001), longer hospital stays (15 ± 14 vs 9 ± 9 days; p = 0.001), higher rate of discharge institutionalization (42% vs 18%; p = 0.001), and higher 6-month mortality (13% vs 5%; p = 0.040). Adjusting for potential confounders determined by univariate analysis, logistic regression found impaired cognition was still associated with the occurrence of 1 or more postoperative complications (odds ratio = 2.401; 95% CI, 1.185−4.865; p = 0.015). Kaplan-Meier survival analysis revealed higher mortality in the impaired cognition group (log-rank p = 0.008). Conclusions: Baseline cognitive impairment in older adults undergoing major elective operations is related to adverse postoperative outcomes including increased complications, length of stay, and long-term mortality. Improved understanding of baseline cognition and surgical outcomes can aid surgical decision making in older adults. [Copyright &y& Elsevier]

Aim: To examine the usefulness of dual-phase 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET) for the evaluation of thyroid incidentalomas. Materials and methods: In this retrospective study, cases with focal thyroid lesions seen incidentally at FDG PET in which the histopathological diagnosis was available and in which dual-phase FDG PET imaging was performed at 1 and 2 h after FDG injection were reviewed. In the included cases, the 1 and 2 h maximal standard uptake value (1-hour maximal SUV and 2-hour maximal SUV, respectively) and retention index (RI) were calculated, and the differences between benign and malignant thyroid incidentalomas were analysed. Receiver operating characteristic (ROC) analysis was performed to evaluate the ability of 1-hour maximal SUV, 2-hour maximal SUV, and RI to discriminate benign from malignant lesions. Results: A total of 39 patients (25 females, 14 males) with 45 lesions (17 malignant, 28 benign) were included. In malignant thyroid incidentalomas, the average 1-hour maximal SUV, 2-hour maximal SUV, and RI were 5.20, 5.72, and 7.67%, respectively, and in benign thyroid incidentalomas the values were 4.67, 4.97, and 7.38%, respectively. There were no significant differences in 1-hour maximal SUV, 2-hour maximal SUV, and RI between benign and malignant lesions. The area under the ROC curve did not differ from 0.5. Conclusion: Dual-phase FDG PET is not useful for differentiating benign from malignant thyroid incidentalomas. [ABSTRACT FROM AUTHOR]

Abstract: Background: The purpose of this study was to determine the relationship of frailty and 6-month postoperative costs. Methods: Subjects aged ≥ 65 years undergoing elective colorectal operations were enrolled in a prospective observational study. Frailty was assessed by a validated measure of function, cognition, nutrition, comorbidity burden, and geriatric syndromes. Frailty was quantified by summing the number of positive characteristics in each subject. Results: Sixty subjects (mean age, 75 ± 8 years) were studied. Inpatient mortality was 2% (n = 1). Overall, 40% of subjects (n = 24) were considered nonfrail, 22% (n = 13) were prefrail, and 38% (n = 22) were frail. With advancing frailty, hospital costs increased (P < .001) and costs from discharge to 6-months increased (P < .001). Higher degrees of frailty were related to increased rates of discharge institutionalization (P < .001) and 30-day readmission (P = .044). Conclusions: A simple, brief preoperative frailty assessment accurately forecasts increased surgical hospital costs and postdischarge to 6-month healthcare costs after colorectal operations in older adults. [Copyright &y& Elsevier]

Abstract: Background: Urinary bladder rupture is a complication of both blunt and penetrating trauma. Significant morbidity and mortality can result from a missed rupture and its ensuing complications. Patients who are at risk for traumatic bladder rupture should undergo appropriate testing to expedite the diagnosis. Current diagnostic modalities include computed tomography (CT) cystography, and retrograde cystography. Although these modalities carry a sensitivity and specificity of 95–99% and 95–100%, their utility is limited by the resources and staff available. Furthermore, both techniques require that a potentially hemodynamically unstable trauma patient be transported out of the Emergency Department for the entire duration of the procedure. Objective: The following case report reviews the incidence and management of traumatic bladder rupture and describes how emergency physicians (EP) can use ultrasound to make this diagnosis quickly and safely at the bedside. Case Report: The case report describes a patient involved in a motor vehicle collision with a history concerning for urinary bladder injury. A bedside ultrasound study performed by the EP was used to establish the diagnosis of urinary bladder rupture. The ultrasound demonstrated a small contracted urinary bladder with copious free fluid anterior to the bladder wall. The diagnosis was confirmed by CT and the patient was taken expeditiously to the operating room. Conclusion: This case provides an example of how bedside ultrasound can be used to make an accurate and timely diagnosis of urinary bladder rupture and help expedite patient care. [Copyright &y& Elsevier]

Abstract: An investigation was conducted in electrochromic performance of organotungsten oxide WO x C y films deposited onto 40Ω/square flexible PET (polyethylene terephthalate)/ITO (indium tin oxide) substrates using atmospheric pressure plasma jet (APPJ) at various precursor injection angles. A precursor [tungsten carbonyl, W(CO)6;TC] vapor, carried by argon gas, was injected into air plasma torch. The APPJ-synthesized WO x C y films were proven to offer extraordinary electrochromic performance. Cyclic voltammetry (CV) switching measurements indicated that only low driving voltages from −1 to +1V are needed to offer reversible Li+ ion intercalation and de-intercalation in a 1M LiClO4–propylene carbonate (PC) electrolyte. Light modulation with up to 72.5% transmittance variation, optical density change of 0.84 and coloration efficiency of 49.6cm2/mC at a wavelength of 797.6nm after 200 cycles of Li+ ion intercalation and deintercalation were obtained. [ABSTRACT FROM AUTHOR]

The large-conductance voltage and calcium-sensitive BK channel is important in many electrically active cells. Its unique sensitivity to both intracellular calcium levels and membrane potential makes it a key regulator of intracellular calcium, a critical second messenger in cells. The BK channel is expressed ubiquitously in the body and has particularly significant roles in the neuronal and smooth muscle cells. More recently, the importance of BK channel in the pathophysiology of hypertension has been demonstrated. In this review, we will focus on function, regulation, and clinical significance of the BK channel. We will also specifically concentrate on one of its β-subunits, β1, which is important in vascular and renal physiology. [ABSTRACT FROM AUTHOR]

Abstract: Context: The successful conduct of clinical trials in palliative care is challenged by low accrual rates, high attrition of study patients during trials, difficulties managing comorbidity, and other factors. But what has been learned about improving the feasibility of palliative care research studies? Objective: To develop standard terms to describe patient accrual, and using these terms, describe an approach to allow investigators to predict trial feasibility. Methods: We proposed a standard language and definitions for specific elements of feasibility within clinical trial design and conduct. We then developed an approach to apply data generated from the use of these terms to allow researchers to predict feasibility at the design stage of a clinical trial''s development. Results: We developed a taxonomy and then retrospectively applied the approach to four trials selected from our library of completed studies, to provide preliminary validity evidence. The approach includes a framework to help predict the number of patients needed to be assessed to achieve a study''s accrual targets, as part of ongoing operational oversight to monitor the conduct and feasibility of a clinical trial. Conclusion: Challenges to successful completion of palliative care trials are prevalent and serious. A taxonomy to characterize the eligible patient pool, and an approach by which feasibility is systematically investigated, hold the promise to enhance the effectiveness of scarce resources applied to palliative and end-of-life research. [Copyright &y& Elsevier]

Cyclin-dependent kinase-5 is widely expressed and predominantly regulated by the non-cyclin activator p35. Since we recently showed that expression of p35 in the kidney is restricted to podocytes, we examined here its function in mice in which p35 was genetically deleted. The mice did not exhibit kidney abnormalities during glomerular development or during adult life. Conditionally immortalized cultured podocytes, derived from these null mice, did not have any change in their morphology, differentiation, or proliferation. However, when these cultured podocytes were exposed to UV-C irradiation, serum depletion, puromycin aminonucleoside, or transforming growth factor-β-1, they showed increased apoptosis compared to those from wild-type mice. Levels of Bcl-2 were decreased in these null podocytes but increased after transduction with human p35. Restoration of p35 or the ectopic expression of Bcl-2 reduced the susceptibility of p35-null podocytes to apoptosis. Experimental glomerulonephritis, characterized by podocyte apoptosis and subsequent crescent formation, was utilized to test these findings in vivo. Podocyte apoptosis was significantly increased in diseased p35-null compared with wild-type mice, accompanied by increased glomerulosclerosis and decreased renal function. Our study shows that p35 does not affect glomerulogenesis but controls podocyte survival following injury, in part, by regulating Bcl-2 expression. [ABSTRACT FROM AUTHOR]

Background: Patients with muscular dystrophy are at risk of developing a dilated cardiomyopathy and can progress to advanced heart failure. At present, it is not known whether such patients can safely undergo cardiac transplantation. Methods: This was a retrospective review of the Cardiac Transplant Research Database, a multi-institutional registry of 29 transplant centers in the United States, from the years 1990 to 2005. The post-cardiac transplant outcomes of 29 patients with muscular dystrophy were compared with 275 non-muscular dystrophy patients with non-ischemic cardiomyopathy, matched for age, body mass index, gender, and race. Results: Becker''s muscular dystrophy was present in 52% of the patients. Survival in the muscular dystrophy patients was similar to the controls at 1 year (89% vs 91%; p = 0.5) and at 5 years (83% vs 78%; p = 0.5). The differences in rates of cumulative infection, rejection, or allograft vasculopathy between the 2 groups were not significant (p > 0.5 for all comparisons). Conclusions: Recognizing the limitations of the present investigation (ie, selection bias and data lacking in the functional capacity of the muscular dystrophy patients), the current study suggests that the clinical outcomes after cardiac transplantation in selected patients with muscular dystrophy are similar to those seen in age-matched patients with non-ischemic cardiomyopathy. [Copyright &y& Elsevier]

Abstract: This study describes the prevalence of childhood traumatic events (CTEs) among adults with comorbid substance use disorders (SUDs) and mental health problems (MHPs) and assesses the relation between cumulative CTEs and adult health outcomes. Adults with SUDs/MHPs (N =402) were recruited from residential treatment programs and interviewed at treatment admission. Exposures to 9 types of adverse childhood experiences were summed and categorized into 6 ordinal levels of exposure. Descriptive analyses were conducted to assess the prevalence and range of exposure to CTEs in comparison with a sample from primary health care. Logistic regression analyses were conducted to examine the association between the cumulative exposure to CTEs and adverse health outcomes. Most of the sample reported exposure to CTEs, with higher exposure rates among the study sample compared with the primary health care sample. Greater exposure to CTEs significantly increased the odds of several adverse adult outcomes, including PTSD, alcohol dependence, injection drug use, tobacco use, sex work, medical problems, and poor quality of life. Study findings support the importance of early prevention and intervention and provision of trauma treatment for individuals with SUDs/MHPs. [Copyright &y& Elsevier]

Abstract: The reaction of 1-alkyl-2-{(o-thioalkyl)phenylazo}imidazoles (SRaaiNR) (2a/2b) with Ru(II) has synthesized [Ru(SRaaiNR)2](ClO4)2 (3a/3b) in 2-methoxyethanol. The reaction in methanol, however, has synthesized [Ru(SRaaiNR)( S RaaiNR)Cl](ClO4) (4a/4b). The solid phase reaction of SRaaiNR and RuCl3 on silica gel surface upon microwave irradiation has synthesized [Ru(SRaaiNR)(SaaiNR)](PF6) (5a/5b) [SRaaiNR represents tridentate N,N′,S-chelator; S RaaiNR is N,N′-bidentate chelator where S does not coordinate and SaaiNR refers N,N′,S-chelator where S refers to thiolato binding]. The structural characterization of [Ru(SEtaaiNEt)( S EtaaiNEt)Cl](ClO4) (4b) and [Ru(SEtaaiNEt)(SaaiNEt)](PF6) (5b) has been confirmed by single crystal X-ray diffraction study. The IR, UV–Vis, and 1H NMR spectral data also support the stereochemistry of the complexes. The complexes show metal oxidation, Ru(III)/Ru(II), and ligand reductions (azo/azo−, azo−/azo ). The molecular orbital diagram has been drawn by density functional theory (DFT) calculation. Normal mode of analysis has been performed to correlate calculated and experimental frequencies of representative complexes. The electronic movement and assignment of electronic spectra have been carried out by TDDFT calculation both in gas and acetonitrile phase. [Copyright &y& Elsevier]

Abstract: Background: Malfunctioning or dislodged gastrostomy tubes (G-tubes) often require urgent replacement and reinsertion in the Emergency Department (ED). Few data exist regarding the best technique for bedside catheter replacement and verification, and individual operator preferences vary. Although a few reports have described the use of ultrasound guidance during the initial percutaneous insertion, no data are available concerning its role during subsequent G-tube replacements. Objective: We sought to investigate the utility of bedside ultrasonography during G-tube replacements in the ED. Methods: This was a prospective pilot study conducted at a Level 1 Trauma Center with an annual census of 90,000 patients. Seven adults and three children with malfunctioning G-tubes were enrolled. Three tubes were cracked and leaking, and seven tubes had been dislodged. Under ultrasound, a new G-tube was inserted through the previously fashioned tract. After insertion, color Doppler was applied over the catheter tip to enhance visualization during gentle tube oscillation. Results: Ultrasound successfully visualized G-tube replacement in all 10 patients. Application of color Doppler over the G-tube tip during catheter oscillation enhanced placement confirmation. Sonographic findings were corroborated with gastric content aspiration, contrast-enhanced radiographs, and successful use of the new G-tubes. No false tracts were identified during ultrasound-guided insertion, post-procedure sonographic confirmation, or subsequent radiographs. Conclusion: The improper replacement of a G-tube can lead to devastating consequences. Verifying appropriate placement through aspirate evaluation can be misleading, and post-procedure radiographs increase radiation exposure and ED wait times. Bedside ultrasonography can be used to guide catheter insertion while providing a safe and quick adjunct to confirm proper G-tube placement. [Copyright &y& Elsevier]

Abstract: Let be the th order statistic of for , where ''s follow independent normal distributions with respective means and common variance . In this paper, we provide a stochastic ordering of the random vector as the ''s change for any given . With this result and the assumption of effect sparsity, we construct a step-up simultaneous testing procedure that strongly controls experimentwise error rate for a sequence of null hypotheses regarding the number of negligible effects (zero ''s) in orthogonal saturated designs. [Copyright &y& Elsevier]

Abstract: It is often necessary to conduct a pilot study to determine the sample size required for a clinical trial. Due to differences in sampling environments, the pilot data are usually discarded after sample size calculation. This paper tries to use the pilot information to modify the subsequent testing procedure when a two-sided -test or a regression model is used to compare two treatments. The new test maintains the required significance level regardless of the dissimilarity between the pilot and the target populations, but increases the power when the two are similar. The test is constructed based on the posterior distribution of the parameters given the pilot study information, but its properties are investigated from a frequentist''s viewpoint. Due to the small likelihood of an irrelevant pilot population, the new approach is a viable alternative to the current practice. [Copyright &y& Elsevier]

The ranking and selection problem has been well-studied in the case of continuous responses. In this paper, we address the situation in which continuous responses are replaced by discrete orderings. When individuals in the population provide exhaustive rank-orderings of the alternatives, two common decision rules are the majority rule and the rank-sum method. In the former case, the alternative receiving the most first-place votes is declared superior, while in the latter, the alternative with the smallest rank-sum is deemed the best. Both the Pitman efficiencies and the lower bounds on Bahadur efficiencies of the majority rule relative to the rank-sum method are derived, assuming that the rank data are generated from either the Plackett–Luce or the translative strengths models. In addition, finite sample properties of the two methods are compared with the maximum likelihood approach through simulation studies. Our results suggest two things. First, when it is substantially more difficult to obtain a complete rank-ordering than simply the top choice, the majority rule performs adequately and efforts would be better spent asking many voters to provide top choice rather than fewer voters to provide complete orderings. Second, the rank-sum rule compares favorably to, and is substantially more robust than, the maximum likelihood approach. [Copyright &y& Elsevier]

Abstract: An in vitro adhesion test method has been adapted to quantify the through-thickness intercellular delamination energy of isolated human stratum corneum (SC). Both untreated and delipidized tissues were tested. Measured delamination energies were found to increase from ∼3J/m2 near the surface to ∼15J/m2 for the inner layers of the tissue. For delipidized SC, the location of the initial debond was located closer to the center of the tissue. Delamination energy values were elevated compared to untreated specimens, increasing from ∼7J/m2 near the surface to ∼18J/m2 for the inner layers of the SC. Further tests were run to measure delamination energies of SC as a function of hydration (15–100% relative humidity (RH)) at ∼25°C and as a function of temperature (10–90°C) at several hydrations (15, 45, 100% RH). Delamination energies were observed to decrease with increasing hydration and increasing temperature with the most significant changes occurring for 100% RH conditioned SC. Additional SC was treated with pH-buffered solutions (pH 4.2, 6.7, 9.9) and selected surfactant solutions (1%, 10% wt/wt sodium dodecyl sulfate (SDS)) for comparison to untreated controls. While statistically significant differences were observed, the SC was found to be resistant to large changes in delamination energy with pH and 1% wt/wt SDS treatments with values in the range 4.2–5.1J/m2 compared to control values of 4.4J/m2. More substantially elevated values were observed for SC treated with a 10%wt/wt SDS solution (6.6J/m2) and a chloroform–methanol extraction (11.2J/m2). [Copyright &y& Elsevier]

Abstract: The calcium-dependent proline-rich tyrosine kinase Pyk2 is activated by tyrosine phosphorylation, associates with focal adhesion proteins, and has been linked to proliferative and migratory responses in a variety of mesenchymal and epithelial cell types. Full Pyk2 activation requires phosphorylation at functionally distinct sites, including autophosphorylation site Tyr-402 and catalytic domain site Tyr-580, though the mechanisms involved are unclear. The pathways mediating Pyk2 phosphorylation at Tyr-402 and Tyr-580 were therefore investigated. Both sites were rapidly and transiently phosphorylated following cell stimulation by Ang II or LPA. However, only Tyr-580 phosphorylation was rapidly enhanced by intracellular Ca2+ release, or inhibited by Ca2+ depletion. Conversely, Tyr-402 phosphorylation was highly sensitive to inhibition of actin stress fibers, or of Rho kinase (ROK), an upstream regulator of stress fiber assembly. Ang II also induced a delayed (30–60 min) secondary phosphorylation peak occurring at Tyr-402 alone. Unlike the homologous focal adhesion kinase (FAK), Pyk2 phosphorylation was sensitive neither to the Src inhibitor PP2, nor to truncation of its N-terminal region, which contains a putative autoinhibitory FERM domain. These results better define the mechanisms involved in Pyk2 activation, demonstrating that autophosphorylation is ROK- and stress fiber-dependent, while transphosphorylation within the kinase domain is Ca2+-dependent and Src-independent in intestinal epithelial cells. This contrasts with the tight sequential coupling of phosphorylation seen in FAK activation, and further underlines the differences between these closely related kinases. [Copyright &y& Elsevier]

Abstract: The adequate presence of silicon (Si) in rice plants can enhance their yield and improve their tolerance to various biotic and abiotic stresses. In this study Si uptake abilities were compared between the japonica rice cultivar (cv.) Kinmaze and the indica rice cv. DV85 under three Si concentrations (0.16, 0.4, and 1.6mM) at different time points from 1 to 12h. The results showed that the phenotypic values of two traits—Si uptake by individual plants (SP, Si uptake by all roots of a plant) and Si uptake per unit root dry weight (SR=SP/root dry weight)—of Kinmaze were significantly higher than those of DV85 (P <0.01). Meanwhile, a kinetic study indicated that the Si transporters in Kinmaze and DV85 had the same affinity for silicic acid, but with different V max values, indicating that Kinmaze had more Si transporters in the roots than DV85. This may be the main reason for the difference in Si uptake ability between Kinmaze and DV85. In addition, a mapping population consisting of 81 recombinant inbred lines (RILs) derived from the cross between Kinmaze and DV85 was used to detect quantitative trait loci (QTLs) underlying SP and SR. The RILs follow a continuous one-peak distribution and show transgressive segregation in both directions for SP, SR, and root dry weight (RDW). Three QTLs for SP, four for SR, and three for RDW were detected. This can explain 7.16–17.15% of the phenotypic variation (PVE). Thus, the results obtained in this study provide a better understanding of the mechanism of rice Si uptake ability and the basis for fine-mapping the genes involved. [Copyright &y& Elsevier]

Abstract: Body weight support (BWS) is frequently used to retrain standing and walking in persons post spinal cord injury (SCI), but the effects of leg unloading using BWS on H-reflex excitability in this population are unknown. The purpose of the study was to assess the effect of two different loading conditions on soleus H-reflex while standing in persons with motor incomplete SCI (i-SCI) and non-injured persons. Eight persons with motor i-SCI (mean age 50.25 years) and five non-injured persons (mean age 48.6 years) participated in the study. Specific control of the loading conditions was achieved using a BWS system. To compare reflex modulation at 40% versus 0% BWS, soleus H-reflexes were evoked during standing and normalized to the maximum M wave amplitude. These studies revealed that (1) H-reflex excitability is significantly greater after SCI and is exhibited even during quiet standing; and (2) no significant modulation in reflex excitability was observed by change in loading conditions in either the non-injured or the i-SCI subjects. These findings suggest that non-injured persons and persons with i-SCI respond similarly to bilateral limb unloading during standing with no change in H-reflex amplitude. Our results suggest that BWS of up to 40% does not produce detectable changes in the excitability of the soleus H-reflex in persons with i-SCI. [Copyright &y& Elsevier]