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Background and purpose: Visual hallucinations are a common, potentially distressing experience of people with Lewy body disease (LBD). The underlying brain changes giving rise to visual hallucinations are not fully understood, although previous models have posited that alterations in the connectivity between brain regions involved in attention and visual processing are critical. Methods: Data from 41 people with LBD and visual hallucinations, 48 with LBD without visual hallucinations and 60 similarly aged healthy comparator participants were used. Connections were investigated between regions in the visual cortex and ventral attention, dorsal attention and default mode networks. Results: Participants with visual hallucinations had worse cognition and motor function than those without visual hallucinations. In those with visual hallucinations, reduced functional connectivity within the ventral attention network and from the visual to default mode network was found. Connectivity strength between the visual and default mode network correlated with the number of correct responses on a pareidolia task, and connectivity within the ventral attention network with visuospatial performance. Conclusions: Our results add to evidence of dysfunctional connectivity in the visual and attentional networks in those with LBD and visual hallucinations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the contribution of the Adelaide Rural Clinical School (ARCS) longitudinal integrated clerkship to the rural medical workforce. Methods: Design: Retrospective cohort study. Setting: Practice location data were sourced from the Australian Health Practitioner Regulation Agency (AHPRA, January 2021) and matched using university records. Participants: University of Adelaide medical school alumni graduating between 2004 and 2019 (ARCS alumni who completed a full year of rural training [n = 423], metropolitan‐trained peers [n = 1655]). Main outcome measures: The proportions of medical graduates working in a rural location (Modified Monash Model [MMM3‐7] or Australian Statistical Geography Standard [ASGS‐RA2‐5] classifications). Logistic regression was used to examine the association between ARCS training and working rurally, and the influence of rural background and sociodemographic factors. Results: Working in a rural location was almost three times more frequent among ARCS alumni than their metropolitan‐trained peers, using the MMM3‐7 (14.7% vs. 5.3%) classification; for ASGS‐RA2‐5 classification (21.3% vs. 8.9%). In adjusted analysis, working rurally (MMM3‐7) was associated with having a rural/remote residence on enrolment (OR 8.29, 95% CI 4.22–16.26) and was 3.1 times more likely for ARCS alumni (OR 3.06, 95% CI 2.06–4.53) than their peers. The magnitude of the effects of ARCS training on whether they are working rurally was similar among those with metropolitan or rural background (p‐value for interaction 0.873). Similar associations were observed using ASGS‐RA2‐5 classifications. Conclusions: Extended rural placements through the Adelaide Rural Clinical School increased the rural medical workforce, with a similar impact among those with a rural or metropolitan background. [ABSTRACT FROM AUTHOR]

Background: RhD‐negative blood products are in chronic short supply leading to renewed interest in utilizing RhD‐positive blood products for emergency transfusions. This study assessed parental perceptions of emergency RhD‐positive blood use in children. Methods: A survey of parents/guardians was conducted on their tolerance of transfusing RhD‐positive blood to RhD‐negative female children ≤17 years old at four level 1 pediatric hospitals. Results: In total, 621 parents/guardians were approached of whom 378/621 (61%) completed the survey in its entirety and were included in the analysis. Respondents were mostly females [295/378 (78%)], White [242/378 (64%)], had some college education [217/378 (57%)] and less than $60,000 annual income [193/378 (51%)]. Respondents had a total of 547 female children. Most children's ABO [320/547 (59%)] and RhD type [348/547 (64%)] were not known by their parents; of children with known RhD type, 58/186 (31%) were RhD‐negative. When the risk of harm to a future fetus was given as 0–6%, more than 80% of respondents indicated that they were likely to accept RhD‐positive blood transfusions on behalf of RhD‐negative female children in a life‐threatening situation. The rate of willingness to accept emergent RhD‐incompatible blood transfusions significantly increased as the potential survival benefit of the transfusion increased. Conclusion: Most parents were willing to accept RhD‐positive blood products on behalf of RhD‐negative female children in an emergency situation. Further discussions and evidence‐based guidelines on transfusing RhD‐positive blood products to RhD‐unknown females in emergency settings are needed. [ABSTRACT FROM AUTHOR]

Objective: The safety of Low Titer Group O Whole Blood (LTOWB) transfusion has not been well‐studied in small children. Methods: This is a single‐center retrospective cohort study of pediatric recipients of RhD‐LTOWB (June 2016–October 2022) who weigh less than 20 kilograms. Biochemical markers of hemolysis (lactate dehydrogenase, total bilirubin, haptoglobin, and reticulocyte count) and renal function (creatinine and potassium) were recorded on the day of LTOWB transfusion and post‐transfusion days 1 and 2. Group O and non‐Group O recipients were compared. Results: Twenty‐one children were included. Their median (interquartile range [IQR]) weight was 12 kg (12–18) with minimum 2.8 kg, and median (IQR) age was 3 years (1.75–5.00) with minimum 0.08 years (29 days old). The most common indication for transfusion was trauma (17/21; 81%). The median (IQR) volume of LTOWB transfused was 30 mL/kg (20–42). There were 9 non‐group O and 12 group O recipients. There were no statistically significant differences in the median concentrations of any of the biochemical markers of hemolysis or the renal function markers between the non‐group O and the group O recipients at any of the three time points (p > 0.05 for all comparisons). There were also no statistically significant differences in demographic parameters or clinical outcomes including 28‐day mortality, length of stay, ventilator days, and venous thromboembolism between the groups. No transfusion reactions were reported in either group. Conclusion: These data suggest LTOWB use is safe in children weighing less than 20 kg. Further multi‐center studies and larger cohorts are needed to confirm these results. [ABSTRACT FROM AUTHOR]

This work demonstrates a large area process for atomically thin 2D semiconductors to unlock the technological upscale required for their commercial uptake. The new atomic layer deposition (ALD) and conversion technique yields large area performance uniformity and tunability. Like graphene, 2D Transition Metal Dichalcogenides (TMDCs) are prone to upscaling challenges limiting their commercial uptake. They are challenging to grow uniformly on large substrates and to transfer on alternative substrates while they often lack in large area electrical performance uniformity. The scalable ALD process of this work enables uniform growth of 2D TMDCs on large area with independent control of layer thickness, stoichiometry and crystallinity while allowing chemical free transfers to application substrates. Field effect transistors (FETs) fabricated on flexible substrates using the process present a field effect mobility of up to 55 cm2/Vs, subthreshold slope down to 80 mV/dec and on/off ratios of 107. In addition, non-volatile memory transistors using ferroelectric FETs (FeFETs) operating at ±5 V with on/off ratio of 107 and a memory window of 3.25 V are demonstrated. These FeFETs demonstrate state-of-the-art performance with multiple state switching, suitable for one-transistor non-volatile memory and for synaptic transistors revealing the applicability of the process to flexible neuromorphic applications. [ABSTRACT FROM AUTHOR]

To investigate the potential therapeutic benefits and tolerability of inhibitory transcranial direct current stimulation (tDCS) on the remediation of visual hallucinations in Charles Bonnet syndrome (CBS). Randomized, double-masked, placebo-controlled crossover trial. Sixteen individuals diagnosed with CBS secondary to visual impairment caused by eye disease experiencing recurrent visual hallucinations. All participants received 4 consecutive days of active and placebo cathodal stimulation (current density: 0.29 mA/cm2) to the visual cortex (Oz) over 2 defined treatment weeks, separated by a 4-week washout period. Ratings of visual hallucination frequency and duration following active and placebo stimulation, accounting for treatment order, using a 2 × 2 repeated-measures model. Secondary outcomes included impact ratings of visual hallucinations and electrophysiological measures. When compared with placebo treatment, active inhibitory stimulation of visual cortex resulted in a significant reduction in the frequency of visual hallucinations measured by the North East Visual Hallucinations Interview, with a moderate-to-large effect size. Impact measures of visual hallucinations improved in both placebo and active conditions, suggesting support and education for CBS may have therapeutic benefits. Participants who demonstrated greater occipital excitability on electroencephalography assessment at the start of treatment were more likely to report a positive treatment response. Stimulation was found to be tolerable in all participants, with no significant adverse effects reported, including no deterioration in preexisting visual impairment. Findings indicate that inhibitory tDCS of visual cortex may reduce the frequency of visual hallucinations in people with CBS, particularly individuals who demonstrate greater occipital excitability prior to stimulation. tDCS may offer a feasible intervention option for CBS with no significant side effects, warranting larger-scale clinical trials to further characterize its efficacy. [ABSTRACT FROM AUTHOR]

Objective: To understand how contemporary socio‐cultural factors may impact medical students' rural career intent. Design: Cross‐sectional study using data from the national Federation of Rural Australian Medical Educators survey. Participants/setting: Medical students across 18 Australian universities who completed a full academic year of clinical training in rural areas in 2019. Main outcome measure(s): Preferred location of practice post‐training reported to be either: (i) a major city; (ii) a regional area or large town; or (iii) a small rural location. Results: In total, 626 students completed the survey (70.1% response rate). A small rural location was the most preferred location of practice after graduation for 28.3% of the students (95% CI 21.6–36.0). Four socio‐cultural factors were positively associated with a preference for a rural career location: poor health status of rural people, motor vehicle traffic congestion in cities, rural generalist training opportunities in the state and the Royal Flying Doctor Service. Other socio‐cultural factors, including specialists' under‐employment, Medicare freeze effect on doctors' income, bullying/sexual harassment in hospitals, climate change/natural disasters or recognised rural health personalities did not influence the investigated outcome. Conclusions: Our findings indicate a novel association between contemporary socio‐cultural factors and rural career intention in a cohort of Australian rural clinical school students. These findings advocate for further consideration of research exploring socio‐cultural factors shaping rural career intent and workforce outcomes. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is a rare cancer in children, with various histologic subtypes and a paucity of data to guide clinical management and predict prognosis. Methods: A multi‐institutional review of children with hepatocellular neoplasms was performed, including demographic, staging, treatment, and outcomes data. Patients were categorized as having conventional HCC (cHCC) with or without underlying liver disease, fibrolamellar carcinoma (FLC), and hepatoblastoma with HCC features (HB‐HCC). Univariate and multivariate analyses identified predictors of mortality and relapse. RESULTS: In total, 262 children were identified; and an institutional histologic review revealed 110 cHCCs (42%; 69 normal background liver, 34 inflammatory/cirrhotic, 7 unknown), 119 FLCs (45%), and 33 HB‐HCCs (12%). The authors observed notable differences in presentation and behavior among tumor subtypes, including increased lymph node involvement in FLC and higher stage in cHCC. Factors associated with mortality included cHCC (hazard ratio [HR], 1.63; P =.038), elevated α‐fetoprotein (HR, 3.1; P =.014), multifocality (HR, 2.4; P <.001), and PRETEXT (pretreatment extent of disease) stage IV (HR, 5.76; P <.001). Multivariate analysis identified increased mortality in cHCC versus FLC (HR, 2.2; P =.004) and in unresectable tumors (HR, 3.4; P <.001). Disease‐free status at any point predicted survival. Conclusions: This multi‐institutional, detailed data set allowed a comprehensive analysis of outcomes for children with these rare hepatocellular neoplasms. The current data demonstrated that pediatric HCC subtypes are not equivalent entities because FLC and cHCC have distinct anatomic patterns and outcomes in concert with their known molecular differences. This data set will be further used to elucidate the impact of histology on specific treatment responses, with the goal of designing risk‐stratified algorithms for children with HCC. Lay Summary: This is the largest reported granular data set on children with hepatocellular carcinoma.The study evaluates different subtypes of hepatocellular carcinoma and identifies key differences between subtypes.This information is pivotal in improving understanding of these rare cancers and may be used to improve clinical management and subsequent outcome in children with these rare malignancies. Data from this study demonstrated that pediatric hepatocellular carcinoma subtypes are not equivalent entities. This data set of more than 250 children with hepatocellular carcinoma may be used to guide treatment and impact outcomes in children. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that American alligators (Alligator mississippiensis) may be capable of transmitting West Nile virus (WNV) to other alligators. We experimentally exposed 24 juvenile alligators to WNV parenterally or [...]

Introduction: Hallucinations occur across neurodegenerative disorders, with increasing severity, poorer cognition and impaired hallucination-specific insight associated with worse outcomes and faster disease progression. It remains unclear how changes in cognition, temporal aspects of hallucinations, hallucination-specific insight and distress relate to each other. Methods: Extant samples of patients experiencing visual hallucinations were included in the analyses: Parkinson's Disease (n = 103), Parkinson's Disease Dementia (n = 41), Dementia with Lewy Bodies (n = 27) and Eye Disease (n = 113). We explored the relationship between factors of interest with Spearman's correlations and random-effect linear models. Results: Spearman's correlation analyses at the whole-group level showed that higher hallucination-specific insight was related to higher MMSE score (rs = 0.39, p < 0.001) and less severe hallucinations (rs = −0.28, p <.01). Linear mixed-models controlling for diagnostic group showed that insight was related to higher MMSE (p <.001), to hallucination severity (p = 0.003), and to VH duration (p = 0.04). Interestingly, insight was linked to the distress component but not the frequency component of severity. No significant relationship was found between MMSE and hallucination severity in these analyses. Conclusion: Our findings highlight the importance of hallucination-specific insight, distress and duration across groups. A better understanding of the role these factors play in VH may help with the development of future therapeutic interventions trans-diagnostically. [ABSTRACT FROM AUTHOR]

Background: Low titer group O whole blood (LTOWB) is used as the initial resuscitative fluid in an increasing number of pediatric trauma and massive bleeding transfusion protocols. There is little data on adverse events following its transfusion in pediatric trauma patients. Study Design and Methods: Blood bank records were queried for pediatric recipients of at least one unit of red blood cells (RBCs) (component group) or LTOWB (LTOWB group) within 24 h of admission between May 2013 and August 2020. Subjects with early death (<72 h) were excluded. Propensity‐score matching of LTOWB and component groups was performed. Adverse events were recorded, including transfusion reaction, thromboembolism, acute kidney injury, sepsis, and organ failure based on PELOD‐2 score, along with hospital and ICU length of stay (LOS) and ventilator days. Results: Thirty‐six LTOWB recipients were matched to 36 conventional component recipients. Subjects were 52% male, with blunt injury mechanism (82%), median (IQR) injury severity score = 27 (21–35), and 26% in‐hospital mortality. The groups were well matched in terms of demographics and injury characteristics. There were no clinically or statistically significant differences in adverse outcomes including reported transfusion reaction, organ failure, acute kidney injury, sepsis/bacteremia, and venous thromboembolism. Hospital LOS, ventilator days, mortality, and functional disability at discharge were also not significantly different. The LTOWB group had significantly shorter ICU LOS compared to the component group. Conclusion: LTOWB transfusion did not increase the risk of adverse events in children. However, larger studies are required to confirm these results. [ABSTRACT FROM AUTHOR]

Background: Low-titer Group O Whole Blood (LTOWB) is used with increasing frequency in adult and pediatric trauma and massive bleeding transfusion protocols. There is a risk of acute hemolytic reactions in non-group O recipients due to the passive transfusion of anti-A and anti-B in the LTOWB. This study investigated the hemolysis risk among pediatric recipients of LTOWB.Study Design and Methods: Blood bank records were queried for pediatric recipients of LTOWB between June 2016 and August 2020 and merged with clinical data. The primary outcome was laboratory evidence of hemolysis as manifested by changes in lactate dehydrogenase (LDH), haptoglobin, total bilirubin, reticulocyte count, potassium, and creatinine. Per protocol, these values were collected on hospital days 0-2 for recipients of LTOWB. Transfusion reactions were reported to the hospital's blood bank.Results: Forty-seven children received LTOWB transfusion between 2016 and 2020; 21 were group O and 26 were non-group O. The groups were comparable in terms of the total volume of transfused blood products, demographics, and clinical outcomes. The most common indication for LTOWB transfusion was hemorrhagic shock due to trauma. There were no clinically or statistically significant differences in baseline, post-transfusion day 1, or post-transfusion day 2 hemolysis markers between the group O and non-group O LTOWB recipients. There were no adverse events or transfusion reactions reported.Discussion: Use of up to 40 ml/kg of LTOWB appears to be serologically safe for children in hemorrhagic shock. [ABSTRACT FROM AUTHOR]

From man-made satellites and interplanetary missions to fusion power plants, electronic equipment that needs to withstand various forms of irradiation is an essential part of their operation. Examination of total ionizing dose (TID) effects in electronic equipment can provide a thorough means to predict their reliability in conditions where ionizing dose becomes a serious hazard. In this paper, we provide a historical overview of logic andmemory technologies that made the biggest impact both in terms of their competitive characteristics and their intrinsically hardened nature against TID. Further to this, we also provide guidelines for hardened device designs and present the cases where hardened alternatives have been implemented and tested in the lab. The technologies that we examine range from silicon-on-insulator and FinFET to 2-D semiconductor transistors and resistive random access memory. [ABSTRACT FROM AUTHOR]

A controllable transformation from interfacial to filamentary switching mode is presented on a ZrO/ZrO/ZrO tri-layer resistive memory. The two switching modes are investigated with possible switching and transformation mechanisms proposed. Resistivity modulation of the ZrO layer is proposed to be responsible for the switching in the interfacial switching mode through injecting/retracting of oxygen ions. The switching is compliance-free due to the intrinsic series resistor by the filaments formed in the ZrO layers. By tuning the RESET voltages, controllable and stable multistate memory can be achieved which clearly points towards the capability of developing the next-generation multistate high-performance memory. [ABSTRACT FROM AUTHOR]

Primary gastric masses are rare in childhood, and a gastric ganglioneuroma has not been reported in the pediatric population. In this report, we describe a 12-year-old female who presented with iron deficiency anemia and melena. Endoscopy was performed to elucidate the source of her symptoms, and revealed a gastric mass with overlying ulceration. Following resection and pathologic examination, the mass was diagnosed as a solitary polypoid ganglioneuroma. A solitary polypoid ganglioneuroma is an uncommon, benign tumor of neural crest cell origin. They are most often asymptomatic and found incidentally, but can present with rectal bleeding, obstruction, pain, and changes in bowel function. Complete resection is the therapy of choice to prevent progression of symptoms or rare transformation into a malignant neuroblastic tumor, like neuroblastoma. As of the patient's last post-operative appointment, she was healthy with resolution of her anemia. [ABSTRACT FROM AUTHOR]

Resistive random access memory based on TiN/HfOx/TiN has been fabricated, with the stoichiometry of the HfOx layer altered through control of atomic layer deposition (ALD) temperature. Sweep and pulsed electrical characteristics were extracted before and after ^60Co gamma irradiation. Monoclinic HfOx deposited at 400 ^\circC did not result in resistive switching. Deposition at 300 ^\circC and 350 ^\circC resulted in cubic HfOx which switched successfully. Both stoichiometric HfO2 and sub-oxides HfO2 - x result in similar memory characteristics. All devices are shown to be radiation hard up to 10 Mrad(Si), independent of stoichiometry. [ABSTRACT FROM PUBLISHER]

A comparison is made of the behavior of silicon on insulator buried oxides and wet thermal oxides before and after fluorine implantation and irradiation. Before irradiation, the electrical characteristics of the thermal oxide and buried oxide are significantly different. The fluorine implantation in the smart-cut ® buried oxide results in a large negative threshold shift due to the trapping of positive charges. These charges are associated with positively charged fluorine ions on implantation and are trapped at pre-existing trap sites, particularly at the bonding interface, and at additional defects caused by the ion implantation damage. This shift is absent in the wet thermal oxide. After Co 60 irradiation up to 500 Krad(Si), the negative flatband and threshold voltage shift in the fluorine implanted buried oxide is larger than in the unimplanted buried oxide indicating that any potential positive effect of fluorine on the passivation of interface states is more than offset by the additional trapping sites created during implantation. These results demonstrate that in the design of a transistor utmost care must be taken to prevent any fluorine being implanted into the buried oxide. [ABSTRACT FROM AUTHOR]