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Transition metal dichalcogenides (TMDC) are a family of atomic‐layer 2D materials (2dMs). Many researches have attempted to reinforce the unique properties by incorporating artificially designed nanostructures. Here, a highly photoluminescence (PL) enhancing platform is reported that is formed by combining high‐emittance plasmo–photonic metasurfaces with a large‐area 2dM, which is a continuous monolayer of TMDC of cm2 dimension. It is experimentally demonstrated that the 2dM‐PL intensity at room temperature is enhanced by more than 1030‐fold in comparison with that observed on the flat gold film regions. The enhancement is associated with spectral transformation indicating a resonant effect of the metasurfaces. It is moreover revealed that the confocal PL image originates from a coherent single‐mode emission that forms a photon number distribution obeying the Poisson probability distribution. Thus, the 2dM‐fused metasurfaces function as efficient coherent quantum light sources. PL decay‐time analysis also reveals the coexistence of two components in the enhanced PL. The fast component exhibits a lifetime of 18 ps whereas the slow component decays at 4.4 ns. Both components are most likely to undergo radiative processes, which indicates that metal‐induced PL quenching is suppressed on these 2dM‐fused metasurfaces. The long lifetime component is ascribed to an excitonic intervalley transition. [ABSTRACT FROM AUTHOR]

With growing concern for the unsustainability of food systems, the international research community has turned its attention to small farms as key actors to potentially face the global food crisis. This study aims to support a policy design that values the diversity of small farms business models vis‐à‐vis environmental, economic, social and institutional challenges affecting European farming systems. Building on the existing classification of five small farm types in the EU, our analysis targets the business model dynamics of small farms in four Euro‐Mediterranean countries: Greece, Italy, Portugal and Spain. For this analysis, we applied resilience thinking to the Business Model Canvas framework. This innovative conceptual framework allows us to depict the architecture of small farms business models and their role in farming systems. The diversity of small farms business models and their continuous adaptation to changing conditions allows for the identification of a strongly heterogeneous assemblage of farms that contribute to the resilience of food systems at local, regional and multiple other scales. [ABSTRACT FROM AUTHOR]

Labour markets around the world are experiencing extraordinary disruption during the COVID‐19 pandemic. The gap in the employment rate between Australians with and without disability is likely to widen, given the entrenched disadvantage of people with disability in the job market. For many, it will compound existing health and economic vulnerabilities. This scenario is troubling from both a human rights and an economic perspective. In this paper, we examine the interface of two policy instruments intended to improve the prospects of people with disability finding and keeping employment in Australia – Disability Employment Services and the National Disability Insurance Scheme – in the lead up to and in the early stages of the COVID‐19 pandemic. Findings from three studies conducted between 2018 and 2020 reveal these instruments are not mutually reinforcing. With a 10‐year National Disability Employment Strategy (NDES) in development under federal government oversight, we argue that more concerted and targeted effort from these services and broader public policies and programs is needed to ensure Australians with disability are not sidelined in the labour market in the wake of the pandemic. We examine the interface of two policy instruments intended to improve the employment prospects of people with disability in Australia. Three recent studies reveal these instruments are not mutually reinforcing. More concerted effort is needed to ensure Australians with disability are not excluded from work in the wake of COVID‐19. [ABSTRACT FROM AUTHOR]

Rural areas are places where various social groups live either permanently or seasonally. The mobilities and immobilities of these groups are related to their differential resources. The vast impact of the financial crisis on Greece relates to the major decline of its GDP and enormous increase in unemployment. The article aims to shed light on the complexities of social marginalisation and social exclusion in rural Greece, but also, and more importantly, to theorise the coping mechanisms and strategies by those affected and build upon the experiences of rural areas during the prolonged economic crisis. Population dynamics and the various social and spatial mobilities in rural areas provide the baseline for tracing rural complexities and theorising the emergent coping strategies. The concepts of rural cosmopolitanism and resilience are used to unpack the complexities of marginalisation and social exclusion in rural Greece. A brief reference to the statistical data resolves the apparent controversies related to the changing regional and local geography of poverty and social exclusion in Greece during the crisis. The more focused empirical findings, illustrated in the form of two island areas, illustrate the various coping mechanisms and strategies that are emerging in rural Greece. [ABSTRACT FROM AUTHOR]

Introduction. Pain after cardiac surgery affects long-term patient wellness. This study investigated the effect of preoperative pregabalin on acute and chronic pain after elective cardiac surgery with median sternotomy. Methods. Prospective double blind study. 93 cardiac surgery patients were randomly assigned into three groups: Group 1 received placebo, Group 2 received oral pregabalin 75 mg, and Group 3 received oral pregabalin 150 mg. Data were collected 8 hours, 24 hours, and 3 months postoperatively. Results. Patients receiving pregabalin required fewer morphine boluses (10 in controls versus 6 in Group 1 versus 4 in Group 2, p=0.000) and had lower pain scores at 8 hours (4 versus 3 versus 3, p=0.001) and 3 months (3 versus 2 versus 2, p=0.000) and lower morphine consumption at 8 hours (14 versus 13 versus 12 mg, p=0.000) and 24 hours (19.5 versus 16 versus 15 mg, p=0.000). Percentage of patients with sleep disturbances or requiring analgesics was lower in the pregabalin group and even lower with higher pregabalin dose (16/31 versus 5/31 versus 3/31, p=0.000, and 26/31 versus 16/31 versus 10/31, p=0.000, resp.) 3 months after surgery. Conclusion. Preoperative oral pregabalin 75 or 150 mg reduces postoperative morphine requirements and acute and chronic pain after cardiac surgery. [ABSTRACT FROM AUTHOR]

Introduction. The prognostic value of age, physical status, and duration of surgery on perioperative course has been extensively studied. However, the impact of deep hypnotic time (time when Bispectral Index values are less than 40) has not been well evaluated. Methods. We designed an observational study to clarify the relative influence of deep hypnotic time (DHT) on outcome. Eligible participants were mentally stable patients over 18 years old scheduled for elective major abdominal surgery. In total, 248 patients enrolled. Data were analyzed using Fisher’s exact test and multiple logistic regression. Results. Five variables (DHT, hypotension, age, comorbidity, and duration of surgery) showed statistically significant association with complications, when examined independently. However, when all variables were examined together in a multiple logistic regression model, age and comorbidity were no longer associated with outcome. DHT, hypotension, and duration of surgery were significant predictors of “complications,” and “hypotension” was a significant predictor of prolonged hospital stay (P<0.001).  Conclusion. Deep hypnotic time emerged as a new factor associated with outcome, and its impact compared to other factors such as age, surgery duration, hypotension, and comorbidity is redefined. Monitoring and managing depth of anesthesia during surgery are important and should be part of careful operation planning. [ABSTRACT FROM AUTHOR]

Introduction. Penile cancer is a rare malignancy often treated with neoadjuvant chemotherapy followed by surgery. However, the utility of neoadjuvant chemoradiation, particularly when the tumor is resistant to chemotherapy alone, has not been established. In this study, we report a case of pT3cN3M0 penile squamous cell carcinoma with progression of nodal disease on chemotherapy, which was cured with use of neoadjuvant concurrent chemoradiation. Case Report. A 65-year-old male presented with a fixed left inguinal lymph node with associated firmness of the penile glans. Biopsies of both sites revealed evidence of squamous cell carcinoma. The patient underwent partial penectomy for the primary lesion and began neoadjuvant chemotherapy to reduce the size of the unresectable left inguinal node. However, he displayed disease progression in the left inguinal node. As such, we attempted concurrent chemoradiation therapy with regression of his nodal disease. The patient was able to undergo left inguinal node dissection and has no evidence of disease 18 months since his initial surgery. Conclusion. The use of neoadjuvant chemoradiation for bulky cN2-3 disease seems appropriate in the setting of progressive disease. Further studies are necessary to assess the utility of concurrent chemoradiation both in the neoadjuvant and salvage setting. [ABSTRACT FROM AUTHOR]

Introduction. Severe leptospirosis, also known as Weil's disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. Methods. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Data were collected retrospectively, with approval from the Institution Ethics Committee. Results. Ten patients with severe leptospirosis were admitted in the Patras University Hospital ICU in a four-year period. Although, based on SOFA scores, predicted mortality was over 80%, seven of 10 patients survived and were discharged from the hospital in good condition. There was no association between SAPS II or SOFA scores and mortality, but survivors had significantly lower APACHE II scores compared to nonsurvivors. Conclusion. Commonly used severity scores do not seem to be useful in predicting mortality in severe leptospirosis. Early ICU admission and resuscitation based on a goal-directed therapy protocol are recommended and may reduce mortality. However, this study is limited by retrospective data collection and small sample size. Data from large prospective studies are needed to validate our findings. [ABSTRACT FROM AUTHOR]

Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The main goal of a prostate biopsy is to identify clinically relevant prostate cancer with the lowest possible morbidity from the procedure. Over time, many have tried different variations in the procedure in an attempt to find the optimal methodology for performing prostate biopsies. These changes include better equipment in helping optimize cancer localization, varying the number of cores in efforts to improve cancer detection, and sampling various areas of the prostate to find cancer that might be difficult to identify. To our knowledge we are the first to describe performing prostate biopsies by keeping the sampling size constant and varying the number of cores based on the size of the prostate. The study adds a variation in the current techniques used for prostate biopsies. In certain situations, using a standard number of cores makes obtaining proper sampling of a prostate difficult. We propose a methodology in performing prostate biopsies that will allow for standardization of the tissue per core analysed, thus improving the sampling of the prostate. OBJECTIVE • To investigate the effect on cancer detection by varying the number of cores taken for prostate biopsy according to the size of the prostate. PATIENTS AND METHODS • A retrospective review of a prospectively registered prostate biopsy database identified 3040 consecutive patients undergoing prostate biopsy at a Veterans Administration Hospital between 1994 and 2008. • Of 2224 biopsies, 681 (31%) were found to have cancer and 1540 (69%) had negative biopsies. • Prostate volume to biopsy core ratios (volume/number of cores) were derived and a comparative analysis was performed to determine the impact on cancer detection rates. RESULTS • The median prostate volume was significantly smaller for those patients diagnosed with prostate cancer than for those with negative biopsies (33 vs 43 cc, P= 0.01). • The median number of cores was the same for both groups of patients (median 12, P= 0.66). • The median transrectal ultrasonography TRUS size/core ratio was 3.5 [interquartile range (IQR) 2.5] for patients with identified cancer as compared with 4.7 (IQR = 3.9) for those with negative biopsies ( P= 0.000). • On multivariable logistic regression analysis TRUS size/core ratio had a significant impact on cancer detection with a relative risk ratio of 1.29 (95% confidence interval, 1.1-1.5, P= 0.001) even when controlled for age, race, prostate volume, digital rectal examination and prostate-specific antigen level. CONCLUSIONS • Prostate cancer detection can be enhanced by individualizing the number of cores performed to a real-time prostate volume sampling. • The present study emphasizes that optimal cancer detection rates were observed when a ratio of 3.5 cc per tissue core was achieved. • Proper prospectively designed studies must be performed to further validate these findings. [ABSTRACT FROM AUTHOR]

Background and objective: Use of opioids is common in perioperative haemodialysis patients because they often suffer from intractable ischaemic or neuropathic lower extremity pain. Intravenous (IV) fentanyl, patient-controlled analgesia (PCA) does not appear to have been evaluated in this setting; hence this study. Methods and results: This is a prospective, single-centre study. IV fentanyl PCA was used for pain control in 16 patients with lower extremity, neuropathic/ischaemic pain, scheduled for major lower extremity amputation. IV fentanyl PCA was used before and after amputation in eight patients, before but not after amputation in seven patients, and until death in one terminal cancer patient who chose to forgo surgery. Pain intensity was assessed with the Visual Analogue Scale (VAS) and the McGill Pain Questionnaire. Depth of sedation was assessed on a 4-point scale. Ischaemic pain scores were high before fentanyl PCA started, but decreased significantly and remained low with fentanyl PCA use ( P < 0·001). Phantom pain scores were low (VAS ≤ 4). Respiratory depression was not a problem in any patient. Conclusions: Concerns about accumulation of active opioid metabolites make provision of adequate analgesia problematic in haemodialysis patients scheduled for amputation, and emergency surgery. Our data on a small patient population suggest that IV fentanyl PCA is safe and effective for severe pain in haemodialysis patients. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to present the construction of a neobladder with a modified pouch technique using 25–35 cm of terminal ileum. Methods: Thirty-eight patients whose pouch was constructed from 25–35 cm of terminal ileum (short pouch [SP] group) were prospectively evaluated vs 41 patients whose pouch was constructed from 50–70 cm of terminal ileum (long pouch group). Pouch volume, post-void residual (PVR) volume, need for catheterization, continence and voiding frequency were evaluated at 3 and 12 months after surgery. Results: SP group patients had significantly smaller pouch capacity (440 vs 840 mL, P < 0.001) at month 12, and smaller PVR at postoperative months 3 (11 [0–43] vs 40 [0–147] mL, P < 0.001) and 12 (10 [0–90] vs 72 [0–570] mL, P < 0.001). SP group patients had significantly higher voiding frequency on postoperative month 3 (10 vs 9, P < 0.001) and 12 (7 vs 6, P < 0.005). Continence was significantly improved in the SP group compared with the long pouch group after 12 months (63.2% vs 34.1%, respectively, P = 0.034). Full continence improved significantly over time ( P < 0.001) in the SP group, from 26.3% at month 3 to 63.2% at month 12. Conclusion: A pouch constructed from 25–35 cm of terminal ileum provides adequate capacity, smaller PVR, satisfactory continence and a better 24-h voiding frequency pattern during the first postoperative year. [ABSTRACT FROM AUTHOR]

Background: Mortality rates from kidney cancer have continued to rise despite increases in the detection of smaller renal tumors and rates of renal surgery. To explore the factors associated with this treatment-outcome discrepancy, the authors evaluated how changes in tumor size have affected disease progression in patients after nephrectomy for localized kidney cancer, and they sought to identify the factors associated with disease progression and overall patient survival after resection for localized kidney cancer.Methods: In total, 1618 patients with localized kidney cancer were identified who underwent nephrectomy at Memorial Sloan-Kettering Cancer Center from 1989 to 2004. Patients were categorized by year of surgery: from 1989 to 1992, from 1993 to 1996, from 1997 to 2000, and from 2001 to 2004. Tumor size was classified according to the following strata: <2 cm, from 2 cm to 4 cm, from 4 cm to 7 cm, and >7 cm. Disease progression was defined as the development of local recurrence or distant metastases. Five-year progression-free survival (PFS) was calculated for patients in each tumor size strata according to the year of operation using the Kaplan-Meier method. The patient-, tumor-, and surgery-related characteristics associated with PFS and overall survival (OS) were explored using univariate analysis, and all significant variables were retained in a multivariate Cox regression analysis.Results: Overall, the number of nephrectomies increased for all tumor size categories from 1989 to 2004. A tumor size migration was evident during this period, because the proportion of patients with tumors <2 cm and with tumors from 2 cm to 4 cm increased, whereas the proportion of patients with tumors >7 cm decreased. One hundred seventy-nine patients (11%) developed disease progression after nephrectomy. Sixteen patients (1%) developed local recurrences, and 163 patients (10%) developed distant metastases. When 5-year PFS was calculated for each tumor size strata according to 4-year cohorts, trends in PFS did not improve or differ significantly over time. Compared with historic cohorts, patients in more contemporary cohorts were more likely to undergo partial nephrectomy rather than radical nephrectomy and were less likely to undergo concomitant lymph node dissection and adrenalectomy. Multivariate analysis demonstrated that pathologic stage and tumor grade were associated with disease progression, whereas patient age and tumor stage were associated with overall patient survival.Conclusions: Despite an increasing number of nephrectomies and a size migration toward smaller tumors, trends in 5-year PFS and OS did not improve or differ significantly over time. These findings require further research to identify causative mechanisms, and they argue for the consideration of active surveillance for patients who have select renal tumors and a re-evaluation of the current treatment paradigm of surgically removing solid renal masses on initial detection. [ABSTRACT FROM AUTHOR]

Purpose: We determined the impact of the 2012 US Preventative Services Task Force recommendation against prostate specific antigen screening on detection rates and biopsy patterns in African American and Caucasian patients.Materials and Methods: Demographics, PSA, transrectal ultrasonography volume and pathologic data were collected on patients who underwent their first ultrasound-guided prostate biopsy between January 2007 and June 2018 at a New York City Veteran Affairs Hospital.Results: 609 biopsies were analysed preguideline (113 per year), and 487 were analysed postguideline (81 per year). There was no significant difference in the detection rates of low, intermediate or high grade PCa in Caucasians. In contrast, African Americans were significantly more likely to be diagnosed with PCa in the postguideline group (56% pre vs 66% post, P = .016), and significantly more likely to be diagnosed with intermediate-high grade PCa (38% pre vs 47% post, P = .038). Before the 2012 USPSTF recommendation, African American and Caucasian patients undergoing their first biopsy were equally likely to be diagnosed with high-grade PCa (11% AA vs 11% CA). After the 2012 decision, we found that African Americans were 50% more likely than Caucasians to be diagnosed with high-grade PCa on first biopsy (10% AA vs 15% CA, P = .008).Conclusions: In the 6 years following the 2012 USPSTF recommendation, detection rates of intermediate-high risk disease remained unchanged for Caucasian patients but have increased significantly for African Americans. The results of our study strongly support the role of routine PSA screening, particularly in higher risk patients such as African Americans. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article by R. E. Ferner regarding methodological difficulties of detecting medication error, published in a previous issue.

A letter to the editor is presented which focuses on an epidemiological study on the prevalence of diabetes mellitus and obesity in adult people in Greece.

Introduction. Sepsis and its consequences such as metabolic acidosis are resulting in increased mortality. Although correction of metabolic acidosis with sodium bicarbonate seems a reasonable approach, there is ongoing debate regarding the role of bicarbonates as a therapeutic option. Methods. We conducted a PubMed literature search in order to identify published literature related to the effects of sodium bicarbonate treatment on metabolic acidosis due to sepsis. The search included all articles published in English in the last 35 years. Results. There is ongoing debate regarding the use of bicarbonates for the treatment of acidosis in sepsis, but there is a trend towards not using bicarbonate in sepsis patients with arterial blood gas pH > 7.15. Conclusions. Routine use of bicarbonate for treatment of severe acidemia and lactic acidosis due to sepsis is subject of controversy, and current opinion does not favor routine use of bicarbonates. However, available evidence is inconclusive, and more studies are required to determine the potential benefit, if any, of bicarbonate therapy in the sepsis patient with acidosis. [ABSTRACT FROM AUTHOR]

Clinical images of a 29-year-old woman with a 12-year history of systemic lupus erythematosus who presented with extensive calcinosis in lupus panniculitis are shown.