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Christian Nilsen,1 Morten Gundersen,1 Per Graae Jensen,1 Kjell Gunnar Gundersen,1 Richard Potvin,2 Øygunn A Utheim,3– 5 Bjørn Gjerdrum1 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Frisco, TX, USA; 3Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 4Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 5The Norwegian Dry Eye Clinic, Oslo, NorwayCorrespondence: Christian Nilsen, Ifocus Eye Clinic, Strandgaten 203, Bergen, 5004, Norway, Tel +47 97189598, Email christian@ifocusstord.noPurpose: The primary objective was to investigate if treatment with artificial tears affected the variability of keratometry measurements for subjects with dry eyes prior to cataract surgery. The secondary objectives were to investigate whether treatment with artificial tears improved refractive precision and whether subjects with non-dry eyes had better refractive precision than subjects with dry eyes.Design: Prospective randomized controlled trial with three arms.Patients and methods: Dry eye diagnostics according to DEWS II were performed, and subjects with dry eyes were randomized to no treatment (group A1) or treatment with artificial tears two weeks prior to cataract surgery (group A2), with the third group (Group B, non-dry eyes) as a control. Keratometry was performed twice at baseline and twice after two weeks at the time of cataract surgery with three different optical biometers. The change in mean variability of keratometry (average K and magnitude of vector differences) and percentages of outliers after two weeks versus baseline were compared for group A2. The refractive and astigmatism prediction errors were calculated eight weeks after cataract surgery and compared for all three groups.Results: One hundred thirty-one subjects were available for analysis. There was no statistically significant difference in the mean variability of keratometry or percentages of outliers for group A2 from baseline to the time of cataract surgery. There was no statistically significant difference in refractive precision (absolute error and astigmatism prediction error) between any groups.Conclusion: Subjects with dry eyes (treated and non-treated) achieved the same refractive precision and percentages of outliers as subjects with non-dry eyes. Treatment with artificial tears for two weeks appeared inadequate to significantly affect variability in biometric measurements for patients with dry eyes prior to cataract surgery. DEWS II criteria for DED may not be optimal in a cataract setting.Keywords: Cataract surgery, non-invasive keratography tear break-up time, ocular surface staining, osmolarity, artificial tears

Per Jensen,1 Christian Nilsen,1 Morten Gundersen,1 Kjell Gunnar Gundersen,1 Rick Potvin,2 Parisa Gazerani,3 Xiangjun Chen,4– 6 Tor P Utheim,3– 8 Øygunn A Utheim4,7,8 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Frisco, TX, USA; 3Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; 4Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 5Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; 6Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; 7Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 8The Norwegian Dry Eye Clinic, Oslo, NorwayCorrespondence: Per Jensen, Ifocus Eye Clinic, Sørhauggata 111, Haugesund, 5527, Norway, Tel +47 906 13 685, Email per@ifocus.noPurpose: To compare the effect of treatment with preservative-free dexamethasone, NSAIDs and trehalose/hyaluronic acid eye drops with the preservative benzalkonium chloride containing dexamethasone and NSAIDs after cataract surgery in dry versus non-dry eyes.Patients and Methods: In this prospective randomized intervention study, dry eye tests were performed before and 6 weeks after cataract surgery. Patients were considered as having dry eye, SDE (sign of dry eye), if at least one of the following dry eye tests were abnormal; corneal fluorescein staining (CFS), non-invasive keratograph breakup time (NIKBUT) or tear osmolarity. Patients with SDE were randomly assigned to one of two groups. Group 1 patients were treated with dexamethasone and bromfenac eye drops with the preservative benzalkonium chloride (BAC). Group 2 patients were treated with preservative-free dexamethasone and preservative-free diclofenac, as well as a preservative-free lubricant with trehalose and hyaluronic acid both before and after surgery. Patients with normal tear film status acted as the control group (group 3) and received same treatment as group 1.Results: A total of 215 patients were enrolled six weeks after surgery, the number of patients with SDE decreased significantly in groups 1 and 2 (p < 0.001). Subjective symptoms and objective measures including osmolarity, NIKBUT, CFS, and tear film thickness (TFT) improved after surgery, tear production remained unchanged, while corneal sensitivity and meibomian gland dysfunction (MGD) parameters worsened. In the control group with normal tear-film status, SDE increased significantly after the surgery (p < 0.001). There were no statistically significant differences in tear film parameters between the three groups after surgery.Conclusion: After cataract surgery, patients with mild to moderate dry eyes may experience improved tear film status and reduced symptoms. However, we found no additional beneficial effect on dry eye parameters with treatment with preservative-free dexamethasone, NSAIDs, and lubricants compared to preservative-containing eye drops.Keywords: sign of dry eye, cataract surgery, osmolarity, corneal fluorescein staining, non-invasive keratograph tear break-up time, ocular surface disease index, meibomian gland dysfunction

Christian Nilsen,1 Morten Gundersen,1 Per Graae Jensen,1 Kjell Gunnar Gundersen,1 Richard Potvin,2 Øygunn A Utheim,3– 5 Bjørn Gjerdrum1 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Frisco, TX, USA; 3Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 4Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 5The Norwegian Dry Eye Clinic, Oslo, NorwayCorrespondence: Christian Nilsen, Ifocus Eye Clinic, Strandgaten 203, Bergen, 5004, Norway, Tel +47 97189598, Email christian@ifocusstord.noPurpose: The primary objective was to investigate if subjects with dry eyes had increased variability of keratometry measurements prior to cataract surgery compared to subjects with non-dry eyes. Secondary objectives were to determine which separate signs affected keratometry.Patients and Methods: This study was part of a prospective interventional randomized controlled trial. After dry eye diagnostics were performed (signs only) subjects were divided into sign of dry eye (SDE) positive and negative groups. To investigate variability, we performed two keratometry measurements for each subject with three different optical biometers: Anterion (OCT optical biometer), Eyestar (combined OCT and reflection-based optical biometer), and Lenstar (reflection based-optical biometer).Results: One hundred and thirty-one subjects were available for analysis. The variability of astigmatism was significantly higher for subjects with hyperosmolarity compared to normal eyes for the Lenstar, as was the percentage of eyes with variability of astigmatism greater than 0.25 D. The percentage of eyes with variability of average K greater than 0.25 D was higher for subjects with non-invasive keratograph break-up time < 10 seconds (NIKBUT positive) compared to normal eyes for the Lenstar.Conclusion: Combined diagnostic criteria (signs only) showed no statistically significant differences for keratometry measurements between SDE positive and negative. Eyes with hyperosmolarity and NIKBUT positive showed statistically higher variability of keratometry measurements compared to normal eyes for Lenstar, but not for the Anterion or Eyestar biometers.Keywords: cataract surgery, sign of dry eye, non-invasive keratography tear break-up time, ocular surface staining, osmolarity

Bjørn Gjerdrum,1 Kjell Gunnar Gundersen,1 Christian Nilsen,1,2 Morten Gundersen,1,2 Per Jensen1,2 1Ifocus Eye Clinic, Stavanger, Norway; 2Faculty of Health Sciences, Oslo Metropolitan University, Oslo, NorwayCorrespondence: Bjørn Gjerdrum, Brønngata 36, Stavanger, 4008, Norway, Tel +47 415 11935, Email bjorn@ifocus.noPurpose: To evaluate the agreement of refractive predictability of a swept-source optical coherence tomography (SS-OCT) biometer, which uses segmental AL calculation, with another SS-OCT biometer, and an optical low coherence reflectometry (OLCR) biometer. The secondary objective was to describe the refractive outcomes, visual acuities, and the agreement of different preoperative biometric parameters.Patients and Methods: The study was a retrospective one-arm study of refractive and visual outcomes after successful cataract surgery. Preoperative biometric data were collected with two different SS-OCT device (Argos, Alcon Laboratories and Anterion, Heidelberg Engineering) and an OLCR device (Lenstar 900, Haag-Streit). The Barrett Universal II formula was used to calculate IOL power for all three devices. Follow-up examination was 1– 2 months after surgery. The main outcome measure, refractive prediction error (RPE), was calculated as the achieved postoperative refraction minus the predicted refraction for each device. Absolute error (AE) was calculated by reducing the mean error to zero.Results: The study included 129 eyes of 129 patients. The mean RPE was 0.06, − 0.14 and 0.17 D for the Argos, Anterion and Lenstar, respectively (p < 0.01). The Argos also had the lowest absolute RPE, while the Lenstar had the lowest median AE, but this was not statistically significant (p > 0.2). The percentages of eyes with RPE within ± 0.5 was 76%, 71%, and 78% for the Argos, Anterion, and Lenstar, respectively. The percentages of eyes with AE within 0.5 D was 79%, 84%, and 82% for the Argos, Anterion and Lenstar, respectively. None of these percentages were statistically significantly different (p > 0.2).Conclusion: All three biometers showed good refractive predictability with no statistically significant differences in AE or percentages of eyes within ± 0.5 D of RPE or AE. The lowest arithmetic RPE was found with the Argos biometer.Keywords: cataract surgery, IOL power, refractive predictability, SS-OCT biometer, segmental AL, OLCR biometer

Per Graae Jensen,1 Morten Gundersen,1 Christian Nilsen,1 Kjell Gunnar Gundersen,1 Rick Potvin,2 Parisa Gazerani,3 Xiangjun Chen,4– 6 Tor P Utheim,3,4,7,8 Øygunn A Utheim4,7,8 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Bend, OR, USA; 3Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; 4Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 5Department of Ophthalmology, Sørlandet Sykehus Arendal, Arendal, Norway; 6Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; 7Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 8The Norwegian Dry Eye Clinic, Oslo, NorwayCorrespondence: Per Graae Jensen, Ifocus Eye Clinic, Djupaskarvegen 64 b, Haugesund, 5561, Norway, Tel +47 906 13 685, Email per@ifocus.noPurpose: To determine the prevalence of dry eye disease (DED) in patients scheduled for cataract surgery in a Norwegian eye clinic.Patients and Methods: 218 patients scheduled for cataract surgery were examined for DED in one randomly selected eye and questioned regarding symptoms and risk factors. Patients were diagnosed with DED if they fulfilled the DEWS II criteria with symptom score > 12/100 with Ocular Surface Disease Index (OSDI) questionnaire, and the presence of any of the three signs: tear osmolarity > 307 mOsm/L in either eye or a difference in osmolarity between the two eyes of > 8 mOsm/L, corneal fluorescein staining (CSF) ≥ grade 2 and non-invasive tear film breakup time (NIKBUT) of < 10 seconds. Additional tests were the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear meniscus height (TMH), Schirmer 1, tear film thickness (TFT), corneal sensitivity and meibography (meiboscore). Dry eye test outcomes were correlated with risk factors for DED.Results: The prevalence of DED was 55.5% according to the DEWS II criteria. The abnormal osmolarity percentage was 66.5, while 29.8% had shortened NIKBUT and 19.7% exhibited CFS ≥ 2. 57% had Schirmer 1 ≤ 10 mm/5 min, and 81.1% had a meiboscore of ≥ 1. 71.2% of subjects scored positive for DED symptoms using the OSDI questionnaire and 69.3% using SPEED. Logistic regression analysis showed that higher age correlated with a lower OSDI symptom score, reduced corneal sensitivity and increased meibomian gland atrophy. Female sex was associated with higher odds of having DED, abnormal NIKBUT and abnormal CFS. Ocular tests for DED did not correlate with OSDI symptom scores when assessed with Spearman`s rank analysis.Conclusion: The prevalence of DED in an elderly Norwegian population scheduled for cataract surgery is high and associated with female sex. There was a lack of correlation between signs and symptoms of DED.Keywords: dry eye disease, cataract surgery, corneal fluorescein staining, ocular surface, osmolarity, non-invasive keratograph tear break up time, NIKBUT, meibomian gland dysfunction

Christian Nilsen,1 Per Graae Jensen,1 Morten Gundersen,1 Øygunn A Utheim,2– 4 Bjørn Gjerdrum,1 Kjell Gunnar Gundersen,1 David Jahanlu,5 Rick Potvin6 1iFocus Øyeklinikk, Haugesund, Norway; 2The Norwegian Dry Eye Clinic, Oslo, Norway; 3Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 4Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 5Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; 6Science in Vision, Bend, OR, USACorrespondence: Christian Nilsen, iFocus Øyeklinikk, Strandgaten 203, Haugesund, 5004, Norway, Tel +47-97189598, Email christian@ifocusstord.noPurpose: The purpose of this study was to evaluate the diagnostic value of inter-eye osmolarity differences in relation to dry eye symptoms and other non-osmolar signs of dry eye disease.Patients and Methods: One hundred ninety one participants who attended a larger interventional study of dry eye disease prior to and after cataract surgery were analyzed for dry eye disease (DED). Dry eye diagnostics were performed for all subjects according to the DEWS II criteria: tear osmolarity was collected from both eyes with the TearLab system, non-invasive Tear film break up time (NIKBUT) was obtained on the test eye with Keratograph and ocular surface staining (OSS) was evaluated using the Oxford schema. The Ocular Surface Disease Index (OSDI) questionnaire was used to assess symptoms. Inter-eye osmolarity greater than 8, which is considered as a sign of DED according to the TearLab user manual, was evaluated and compared with other non-osmolar signs of DED.Results: The 191 subjects were divided into three groups according to osmolarity measurements. Sixty-five subjects had normal osmolarity (below 308 mOsmol/L in both eyes and less than 9 mOsmol/L difference between the eyes), 107 had high osmolarity (308 mOsmol/L or higher in one of the eyes) and 19 had an inter-eye difference > 8 mOsmol/L or higher, with neither eye having osmolarity higher than 307 mOsmol/L. Signs and symptoms in this last group were not correlated with the high osmolarity group or the normal group, though they appeared more similar to the normal group.Conclusion: The diagnostic value of inter-eye osmolarity difference in predicting symptoms or other non-osmolar signs of dry eyes appears weak. Our study suggests that the criterion of an inter-eye difference of 8 mOsmol/L is not a useful cut-off for diagnosing dry eyes based on osmolarity.Keywords: dry eye disease, osmolarity, DEWS II

Bjørn Gjerdrum,1 Kjell Gunnar Gundersen,1 Christian Nilsen,1,2 Morten Gundersen,1,2 Per Jensen1,2 1Ifocus Eye Clinic, Stavanger, Norway; 2Faculty of Health Sciences, Oslo Metropolitan University, Oslo, NorwayCorrespondence: Bjørn Gjerdrum, Ifocus Eye Clinic, Brønngata 36, Stavanger, 4008, Norway, Tel +47 415 11935, Email bjorn@ifocus.no

Abstract This case describes an infiltrating breast tumour with thyroid transcription factor-1 (TTF-1) positive staining and ductal differentiation in a 72-year-old woman. The presence of ductal carcinoma in situ with positive TTF-1 is a strong indication that this is a primary tumour and not a metastasis from lung. On PET scan and CT follow up there were no other tumours found in this patient. We are not aware of any previously reported TTF-1 positive primary breast carcinoma with ductal differentiation.

Abstract Background Nanosecond, megavolt-per-meter pulsed electric fields scramble membrane phospholipids, release intracellular calcium, and induce apoptosis. Flow cytometric and fluorescence microscopy evidence has associated phospholipid rearrangement directly with nanoelectropulse exposure and supports the hypothesis that the potential that develops across the lipid bilayer during an electric pulse drives phosphatidylserine (PS) externalization. Results In this work we extend observations of cells exposed to electric pulses with 30 ns and 7 ns durations to still narrower pulse widths, and we find that even 3 ns pulses are sufficient to produce responses similar to those reported previously. We show here that in contrast to unipolar pulses, which perturb membrane phospholipid order, tracked with FM1-43 fluorescence, only at the anode side of the cell, bipolar pulses redistribute phospholipids at both the anode and cathode poles, consistent with migration of the anionic PS head group in the transmembrane field. In addition, we demonstrate that, as predicted by the membrane charging hypothesis, a train of shorter pulses requires higher fields to produce phospholipid scrambling comparable to that produced by a time-equivalent train of longer pulses (for a given applied field, 30, 4 ns pulses produce a weaker response than 4, 30 ns pulses). Finally, we show that influx of YO-PRO-1, a fluorescent dye used to detect early apoptosis and activation of the purinergic P2X7 receptor channels, is observed after exposure of Jurkat T lymphoblasts to sufficiently large numbers of pulses, suggesting that membrane poration occurs even with nanosecond pulses when the electric field is high enough. Propidium iodide entry, a traditional indicator of electroporation, occurs with even higher pulse counts. Conclusion Megavolt-per-meter electric pulses as short as 3 ns alter the structure of the plasma membrane and permeabilize the cell to small molecules. The dose responses of cells to unipolar and bipolar pulses ranging from 3 ns to 30 ns duration support the hypothesis that a field-driven charging of the membrane dielectric causes the formation of pores on a nanosecond time scale, and that the anionic phospholipid PS migrates electrophoretically along the wall of these pores to the external face of the membrane.

Introduction: In health education, group work is essential to prepare students for working in health care and medical teams. Following the widespread adoption of online teaching, group work increasingly takes place in online environments. Although successful group work can provide good learning outcomes, it is unclear what facilitates or hinders online group work in health science education, and to what extent this topic has been addressed. Thus, this scoping review aimed to identify the facilitators and barriers to online group work in higher health education, provide an overview of the scientific literature related to the topic, and identify knowledge gaps in the research., Methods: This scoping review was guided by the methodological framework described by Arksey and O'Malley, and reporting is in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR). Eight online databases were searched for scientific articles published between 2012 and 2022. At least two researchers independently screened records and full-text articles and charted data including article characteristics and key information related to the research question. Findings were categorized and summarized based on the Community of Inquiry Framework., Results: After screening 3671 records and 466 full-text articles, 39 articles met the inclusion criteria. The review revealed smaller group size, consistency in group composition and joint responsibility to be facilitators. Challenges with group communication, scheduling synchronous meetings and technical issues were identified as barriers. Our findings supported the importance of all three elements of the Community of Inquiry Framework: social, cognitive, and teaching presence., Conclusion: This review provides an overview of facilitators and barriers to online group work in health science education. However, there is a need for further investigation of these factors and studies addressing this topic from the teachers' perspective.

Background: The long-term outcomes of Ulcerative colitis (UC) after discontinuation of biological therapy are largely unknown. There is also a lack of accurate and validated markers that can predict outcome after withdrawal accurately. The aims of this study were to describe the long-term outcomes in UC patients following cessation of anti-TNF therapy and explore potential biomarkers as an approach towards precision medicine., Methods: Seventy-five patients with moderate to severe UC treated to remission with anti-tumor necrosis factor (TNF) were included in the study. This is a follow-up of previously reported UC outcomes. The patients were categorized as either "Remission" or "Relapse". The "Relapse" group was divided into subgroups determined by the highest treatment level needed to obtain remission the last 3 years of observation: non-biological therapy, biological therapy or colectomy. Remission were divided in long term remission (LTR), those using immunomodulating drugs (LTR + imids) and those using only 5-amino-salicylate (5-ASA) treatment (LTR) for the past 3 years. Analyses of mucosal gene expression by real-time PCR were performed., Results: The median (IQR) observation time of all patients included was 121 (111-137) months. Of the 75 patients, 46 (61%) did not receive biological therapy, including 23 (31%) in LTR ± imids. Of these 23 patients, 16 (21%) were defined as LTR with a median observation time of (IQR) 95 (77-113) months. In total 14 patients (19%) underwent colectomy during the 10 years after first remission. Mucosal TNF copies/µg mRNA < 10 000 at anti-TNF discontinuation predicted long-term remission, biological free remission and lower risk of colectomy with a HR 0.36 (0.14-0.92) for long-term remission, HR 0.17 (0.04-0.78) for biological free remission and HR 0.12 (0.01-0.91) for colectomy. IL1RL1 was normalized in LTR phenotype and higher in relapsing UC., Conclusion: In this 10-year follow-up of UC of patients with moderate to severe disease, 61% of patients experience an altered phenotype to a milder disease course without need of biological therapy. Twenty-one percent of the patients were LTR without any medication except of 5-ASA. Mucosal TNF gene expression and IL1RL1- transcripts may be of clinical utility for long term prognosis in development of precision medicine in UC., (© 2022. The Author(s).)

In November 2018, the Woolsey Fire burned north of Los Angeles, CA, USA, potentially remobilizing radioactive contaminants at the former Santa Susana Field Laboratory, a shuttered nuclear research facility contaminated by chemical and radiochemical releases. Wildfire in radiologically contaminated zones is a global concern; contaminated areas around Chernobyl, Fukushima, Los Alamos, and the Nevada Nuclear Test Site have all experienced wildfires. Three weeks after the Woolsey Fire was controlled, sampling of dusts, ashes, and surface soils (n = 360) began and were analyzed by alpha- and beta-radiation counting. Samples were collected up to a 16 km radius from the perimeter of the laboratory. Controls and samples with activities 1σ greater than background were also examined by alpha and/or gamma spectroscopy or Scanning Electron Microscopy with Energy Dispersive X-ray analysis. Of the 360 samples collected, 97% showed activities at or close to site-specific background levels. However, offsite samples collected in publicly-accessible areas nearest to the SSFL site perimeter had the highest alpha-emitting radionuclides radium, thorium, and uranium activities, indicating site-related radioactive material has escaped the confines of the laboratory. In two geographically-separated locations, one as far away as 15 km, radioactive microparticles containing percent-concentrations of thorium were detected in ashes and dusts that were likely related to deposition from the Woolsey fire. These offsite radioactive microparticles were colocated with alpha and beta activity maxima. Data did not support a finding of widespread deposition of radioactive particles. However, two radioactive deposition hotspots and significant offsite contamination were detected near the site perimeter., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Little is known about the burden of atopic dermatitis (AD) encountered in US primary care practices and the frequency and type of skin care practices routinely used in children., Objective: To estimate the prevalence of AD in children 0 to 5 years attending primary care practices in the United States and to describe routine skin care practices used in this population., Design: A cross-sectional survey study of a convenience sample of children under the age of 5 attending primary care practices for any reason., Setting: Ten primary care practices in 5 US states., Results: Among 652 children attending primary care practices, the estimated prevalence of ever having AD was 24% (95% CI, 21-28) ranging from 15% among those under the age of 1 to 38% among those aged 4 to 5 years. The prevalence of comorbid asthma was higher among AD participants compared to those with no AD, namely, 12% and 4%, respectively ( P < .001). Moisturizers with high water:oil ratios were most commonly used (ie, lotions) in the non-AD population, whereas moisturizers with low water:oil content (ie, ointments) were most common when AD was present., Conclusions: Our study found a large burden of AD in the primary care practice setting in the US. The majority of households reported skin care practices that may be detrimental to the skin barrier, such as frequent bathing and the routine use of moisturizers with high water: oil ratios. Clinical trials are needed to identify which skin care practices are optimal for reducing the significant burden of AD in the community., Competing Interests: Conflict of interest: none declared., (© Copyright 2019 by the American Board of Family Medicine.)

Background: We aimed to evaluate the clinical usefulness of qSOFA as a risk stratification tool for patients admitted with infection compared to traditional SIRS criteria or our triage system; the Rapid Emergency Triage and Treatment System (RETTS)., Methods: The study was an observational cohort study performed at one Emergency Department (ED) in an urban university teaching hospital in Norway, with approximately 20,000 visits per year. All patients >16 years presenting with symptoms or clinical signs suggesting an infection (n = 1535) were prospectively included in the study from January 1 to December 31, 2012. At arrival in the ED, vital signs were recorded and all patients were triaged according to RETTS vital signs, presenting infection, and sepsis symptoms. These admission data were also used to calculate qSOFA and SIRS. Treatment outcome was later retrieved from the patients' electronic records (EPR) and mortality data from the Norwegian population registry., Results: Of the 1535 admitted patients, 108 (7.0%) fulfilled the Sepsis2 criteria for severe sepsis. The qSOFA score ≥2 identified only 33 (sensitivity 0.32, specificity 0.98) of the patients with severe sepsis, whilst the RETTS-alert ≥ orange identified 92 patients (sensitivity 0.85, specificity 0.55). Twenty-six patients died within 7 days of admission; four (15.4%) of them had a qSOFA ≥2, and 16 (61.5%) had RETTS ≥ orange alert. Of the 68 patients that died within 30 days, only eight (11.9%) scored ≥2 on the qSOFA, and 45 (66.1%) had a RETTS ≥ orange alert., Discussion: In order to achieve timely treatment for sepsis, a sensitive screening tool is more important than a specific one. Our study is the fourth study were qSOFA finds few of the sepsis cases in prehospital or at arrival to the ED. We add information on the RETTS triage system, the two highest acuity levels together had a high sensitivity (85%) for identifying sepsis at arrival to the ED - and thus, RETTS should not be replaced by qSOFA as a screening and trigger tool for sepsis at arrival., Conclusion: In this observational cohort study, qSOFA failed to identify two thirds of the patients admitted to an ED with severe sepsis. Further, qSOFA failed to be a risk stratification tool as the sensitivity to predict 7-day and 30-day mortality was low. The sensitivity was poorer than the other warning scores already in use at the study site, RETTS-triage and the SIRS criteria.

The objective was to use carbon nanotubes (CNT) coupled with near-infrared radiation (NIR) to induce hyperthermia as a novel non-ionizing radiation treatment for primary brain tumors, glioblastoma multiforme (GBM). In this study, we report the therapeutic potential of hyperthermia-induced thermal ablation using the sequential administration of carbon nanotubes (CNT) and NIR. In vitro studies were performed using glioma tumor cell lines (U251, U87, LN229, T98G). Glioma cells were incubated with CNTs for 24 h followed by exposure to NIR for 10 min. Glioma cells preferentially internalized CNTs, which upon NIR exposure, generated heat, causing necrotic cell death. There were minimal effects to normal cells, which correlate to their minimal uptake of CNTs. Furthermore, this protocol caused cell death to glioma cancer stem cells, and drug-resistant as well as drug-sensitive glioma cells. This sequential hyperthermia therapy was effective in vivo in the rodent tumor model resulting in tumor shrinkage and no recurrence after only one treatment. In conclusion, this sequence of selective CNT administration followed by NIR activation provides a new approach to the treatment of glioma, particularly drug-resistant gliomas.

This paper describes the design, fabrication, packaging and testing of a microlens integrated in a multi-layered MEMS microspectrometer. The microlens was fabricated using modified PDMS molding to form a suspended lens diaphragm. Gaussian beam propagation model was used to measure the focal length and quantify M(2) value of the microlens. A tunable calibration source was set up to measure the response of the packaged device. Dual wavelength separation by the packaged device was demonstrated by CCD imaging and beam profiling of the spectroscopic output. We demonstrated specific techniques to measure critical parameters of microoptics systems for future optimization of spectroscopic devices.

We report the design, integration, and validation of a fluorescence microscopy system for imaging of electroperturbation--the effects of nanosecond, megavolt-per-meter pulsed electric fields on biological cells and tissues. Such effects have potential applications in cancer therapy, gene regulation, and biophysical research by noninvasively disrupting intracellular compartments and inducing apoptosis in malignant cells. As the primary observing platform, an epifluorescence microscope integrating a nanosecond high-voltage pulser and a micrometer electrode chamber enable in situ imaging of the intracellular processes triggered by high electric fields. Using specific fluorescence molecular probes, the dynamic biological responses of Jurkat T lymphocytes to nanosecond electric pulses (nanoelectropulses) are studied with this system, including calcium bursts, the polarized translocation of phosphatidylserine (PS), and nuclear enlargement and chromatin/DNA structural changes.

The high-resolution carbon 1s photoelectron spectrum of trans-1,3-pentadiene has been resolved into contributions from the five inequivalent carbon atoms, and carbon 1s ionization energies have been assigned to each of these atoms. Spectra have also been measured for propene and 1,3-butadiene at better resolution than has previously been available. The ionization energies for the sp2 carbons are found to correlate well with activation energies for electrophilic addition and with proton affinities. Comparing the results for 1,3-pentadiene with those for ethene, propene, and 1,3-butadiene as well as with results of theoretical calculations makes it is possible to assess the effect of the terminal methyl group in 1,3-pentadiene. As in propene, the methyl group contributes electrons to the beta carbon through the pi system. In addition, there is a significant (though smaller) contribution from the methyl group to the terminal (delta) CH2 carbon, also through the pi system. Most of the effect of the methyl group is present in the ground-state molecule. There are only relatively small contributions from the methyl group to the ionization energies from redistribution of charge in the pi system in response to the removal of a core electron. In addition to these specific effects, there is an overall decrease in average ionization energy as the size of the molecule increases as well as effects that are specific to the conjugated systems in 1,3-butadiene and 1,3-pentadiene. The results provide insight into the reactivity and regioselectivity of conjugated dienes.

Free-text or natural language documents make up an increasing part of the computerized medical record. While they do provide accessible clinical information to health care personnel, they fail to support processes that require clinical data coded according to a shared lexicon and data structure. We have developed a natural language parser that converts free-text admitting diagnoses into a coded form. This application has proven acceptably accurate in the experimental laboratory to warrant a test in the target clinical environment. Here we describe an approach to moving this research application into a production environment where it can contribute to the efforts of the Health Information Services Department. This transition is essential if the products of natural language understanding research are to contribute to patient care in a routine and sustainable way.

In this paper several optical processes that may be used to affect gas-phase switch performance and operation are discussed, and approaches using a laser to increase recovery rates of switches are presented. In the latter the laser is used during the recovery phase rather than the conductive or closure phase. This paper suggests that it should be possible to use a low-power laser (e.g., one that is technologically feasible to use as part of a switch) to assist in opening the switch by quenching excited atomic and/or molecular species. The application of laser-induced energy extraction to gas-phase switches is also discussed.

Single longitudinal mode output of a pulsed TE CO(2) laser has been obtained using several different intracavity gas-phase absorbers. The method described is simple and inexpensive and appears to be extremely general.