Search

Hyperparathyroidism is defined as excessive parathyroid hormone production. The diagnosis is made through biochemical testing, in which imaging has no role. However, imaging is appropriate for preoperative parathyroid gland localization with the intent of surgical cure. Imaging is particularly useful in the setting of primary hyperparathyroidism whereby accurate localization of a single parathyroid adenoma can facilitate minimally invasive parathyroidectomy. Imaging can also be useful to localize ectopic or supernumerary parathyroid glands and detail anatomy, which may impact surgery. This document summarizes the literature and provides imaging recommendations for hyperparathyroidism including primary hyperparathyroidism, recurrent or persistent primary hyperparathyroidism after parathyroid surgery, secondary hyperparathyroidism, and tertiary hyperparathyroidism. Recommendations include ultrasound, CT neck without and with contrast, and nuclear medicine parathyroid scans. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Basketing plays an important role during flexible ureteroscopy, but it can be time-consuming, especially when fragments are too large to pass through the ureteral access sheath. We aim to present the optimal on-screen, endoscopic stone size that predicts successful basketing through various access sheaths. A tipless basket, individually extended to 5 mm from multiple ureteroscopes: (Flex-Xc, Karl Storz; Flex-X2s, Karl Storz; LithoVue, Boston Scientific; or URF-P6R, Olympus) and via differently sized access sheaths (10–12 Fr through 13–15 Fr), was used in retrieval attempts of various artificial stone sizes (2 mm through 5 mm). A relative endoscopic stone size was recorded as the stone’s maximum diameter on endoscopic view compared to the total image diameter. Basketing of stones up to 2.5 mm, yielding relative endoscopic stone sizes of 0.38 (Flex-Xc), 0.30 (Flex-X2s), 0.32 (LithoVue), and 0.34 (URF-P6R), was successful using all access sheaths. Only the 12–14 Fr and greater sheaths allowed for successful basketing of 3 mm stones. Larger stones did not successfully pass through any of the access sheaths. Successful stone retrieval can be predicted by estimating the stone’s size on screen, which is influenced by the type of flexible ureteroscope and access sheath. In our testing, stones of approximately one-third of the screen size passed successfully in all cases.

1AbstractBayesian phylogenetic methods have gained substantial popularity in the last decade, due to their ability to incorporate independent information and fit complex models. Most Bayesian implementations rely on Markov chain Monte Carlo (MCMC), which in turn requires careful interpretation of the output to assess the statistical validity of any resulting inferences. Here we describe Beastiary, a package for real-time and remote inspection of log flies generated by MCMC analysis commonly utilised in Bayesian phylogenetic analysis. Beastiary is an easily deployed web-sever that can be used to summarise and visualise the output of many popular software packages including BEAST, BEAST2, RevBayes, and MrBayes. We describe the overall design and implementation of Beastiary and some typical use cases, with a particular focus on the capability of monitoring analyses from remote servers.

Background: Historically, exocrine pancreas secretions during pancreas transplant were commonly managed by bladder drainage. Although this technique has fallen out of favor because of significant rates of urologic complications, urologists must still be prepared to assist when they arise. We describe the first reported case of a cystoscopically placed pancreatic duct stent for management of a pancreas transplant duodenocystostomy leak in the setting of normal bladder function. Case Presentation: A 63-year-old male with a history of type 1 diabetes mellitus complicated by end-stage renal disease underwent a simultaneous bladder-drained pancreas and kidney transplant 25 years ago. He developed hematuria and acute rejection of his pancreas, with CT showing large volume ascites concerning for pancreatic leak. Cystoscopy revealed an intact and patent duodenal-cystostomy anastomosis; however, intraperitoneal extravasation on intraoperative cystogram raised concern for pancreatic head necrosis. The patient underwent intraperitoneal drain placement and Foley catheter bladder decompression, but drain output and drain amylase and lipase remained markedly elevated. He was taken back to the operating room for attempted cystoscopic stenting of the pancreatic duct, which was effective using a 5F × 4 cm Zimmon(®) pancreatic stent. His drain output normalized in the following days and the pancreatic stent and intraperitoneal drain were removed 4 and 5 weeks after discharge, respectively. Outpatient urodynamics revealed no signs of obstruction and his catheter was removed with minimal postvoid residuals on follow-up. Conclusion: Anastomotic leak after duodenocystostomy during pancreas transplant is a complication typically related to elevated intravesical pressures, managed with bladder decompression and subsequent bladder outlet procedure. We present a novel technique for cystoscopic pancreatic duct stenting in the setting of intact anastomosis and normal bladder function with delayed leak secondary to necrotic pancreatic head. Endoscopic stent placement, intraperitoneal drainage, and bladder decompression with Foley catheter are an effective technique to avoid unnecessary reconstructive surgery.

This research note addresses the difficulties in acquiring interview partners within the Deutsche Forschungsgemeinschaft-funded project ‘Neighbourhood in the tourist trap? An examination on the changing residential quality through tourist accommodation in selected Berlin residential neighbourhoods’. The research project is analysing to what extent the quality of residential areas has changed as a result of tourist accommodation through a mixed-method approach. In order to ensure a differentiated database, one aim of the project was to interview residents with different durations of residency and educational levels, and to take into account the high density of people with a migration background in Berlin. Since Berliners of Turkish origin represent the largest group of people with a migration background in Berlin, it was in the interest of the research to make this group’s views visible and voices heard. In the research note we focus on the acquisition of Turkish Berliners and reflect on the question of why establishing contacts with Turkish Berliners was especially challenging. In order to answer this question, some hypotheses on non-response conduct will be sketched from which we draw our conclusions of an alteration of acquisition within the field of New Urban Tourism in Berlin.

Among all plasmonic metals, copper (Cu) has the greatest potential for realizing optoelectronic and photochemical hot-carrier devices, thanks to its CMOS compatibility and outstanding catalytic properties. Yet, relative to gold (Au) or silver (Ag), Cu has rarely been studied and the fundamental properties of its photoexcited hot carriers are not well understood. Here, we demonstrate that Cu nanoantennas on p-type gallium nitride (p-GaN) enable hot-hole-driven photodetection across the visible spectrum. Importantly, we combine experimental measurements of the internal quantum efficiency (IQE) with ab initio theoretical modeling to clarify the competing roles of hot-carrier energy and mean-free path on the performance of hot-hole devices above and below the interband threshold of the metal. We also examine Cu-based plasmonic photodetectors on corresponding n-type GaN substrates that operate via the collection of hot electrons. By comparing hot hole and hot electron photodetectors that employ the same metal/semiconductor interface (Cu/GaN), we further elucidate the relative advantages and limitations of these complementary plasmonic systems. In particular, we find that harnessing hot holes with p-type semiconductors is a promising strategy for plasmon-driven photodetection across the visible and ultraviolet regimes. Given the technological relevance of Cu and the fundamental insights provided by our combined experimental and theoretical approach, we anticipate that our studies will have a broad impact on the design of hot-carrier optoelectronic devices and plasmon-driven photocatalytic systems.

Designing a scalable system to capture CO₂ from the air and convert it into valuable chemicals, fuels, and materials could be transformational for mitigating climate change. Climate models predict that negative greenhouse gas emissions will be required by the year 2050 in order to stay below a 2 °C change in global temperature. The processes of CO₂ capture, CO₂ conversion, and finally product separation all require significant energy inputs; devising a system that simultaneously minimizes the energy required for all steps is an important challenge. To date, a variety of prototype or pilot-level CO₂ capture and/or conversion systems have been designed and built targeting the individual objectives of either capture or conversion. One approach has focused on CO₂ removal from the atmosphere and storage of pure pressurized CO₂. Other efforts have concentrated on CO₂ conversion processes, such as electrochemical reduction or fermentation. Only a few concepts or analyses have been developed for complete end-to-end processes that perform both CO₂ capture and transformation.

Introduction:We determined the usefulness of ultrasound compared to cross-sectional imaging in the detection of intra-abdominal recurrences after radical or partial nephrectomy for localize...

Key Points Question What is the possible role of children in SARS-CoV-2 transmission? Findings This cohort study including 63 children and 118 adults found no significant difference between the number of children and the number of adults testing positive for SARS-CoV-2 infection during the study period; children were asymptomatic significantly more often compared with adults (46% vs 13%). In addition, a reconstruction of the outbreak showed that most transmission events originated from within the school. Meaning These results suggest that children may play a larger role in the transmission of SARS-CoV-2 than previously assumed., Importance Recent data suggest a relatively low incidence of COVID-19 among children. The possible role that children attending primary school may play in the transmission of SARS-CoV-2 remains poorly understood. Objective To gain a better understanding of the possible role of children in the transmission of SARS-CoV-2. Design, Setting, and Participants This prospective cohort study was conducted from September 21 to December 31, 2020, in a primary school in Liège, Belgium, among a volunteer sample of 181 children, parents, and school employees. Exposures Participants were tested for SARS-CoV-2 infection once a week for 15 weeks through throat washing, performed with 5 mL of saline and collected in a sterile tube after approximately 30 seconds of gargling. Quantitative reverse transcription–polymerase chain reaction was performed to detect SARS-CoV-2 infection. Main Outcomes and Measures In case of test positivity, participants were asked to complete a questionnaire aimed at determining the timing of symptom onset and symptom duration. SARS-CoV-2 genetic sequencing was also performed. Confirmed cases were linked based on available information on known contacts and viral sequences. Results A total of 181 individuals participated in this study, including 63 children (34 girls [54.0%]; mean [SD] age, 8.6 [1.9] years [range, 5-13 years]) and 118 adults (75 women [63.6%]; mean [SD] age, 42.5 [5.7] years [range, 30-59 years]). Forty-five individuals (24.9%) tested positive: 13 children (20.6%; 95% CI, 10.6%-30.6%) and 32 adults (27.1%; 95% CI, 19.1%-35.7%) (P = .34). Children were more often asymptomatic compared with adults (6 [46.2%; 95% CI, 19.1%-73.3%] vs 4 of 31 [12.9%; 95% CI, 1.3%-24.5%]; P = .04). The median duration of symptoms was shorter in children than in adults (0.00 days [IQR, 0.00-1.00 days] vs 15.00 days [IQR, 7.00-22.00 days]). A reconstruction of the outbreak revealed that most transmission events occurred between teachers and between children within the school. Of the observed household transmission events, most seemed to have originated from a child or teacher who acquired the infection at school. Conclusions and Relevance Despite the implementation of several mitigation measures, the incidence of COVID-19 among children attending primary school in this study was comparable to that observed among teachers and parents. Transmission tree reconstruction suggests that most transmission events originated from within the school. Additional measures should be considered to reduce the transmission of SARS-CoV-2 at school, including intensified testing., This cohort study uses data from a primary school in Belgium to examine the possible role of children in the transmission of SARS-CoV-2.

BackgroundThe use of antibiotics (ATB) and proton-pump inhibitors (PPI) alters the composition and diversity of the gut microbiota, which can influence the immune system, consequently interfering with response to anti-PD1 immune checkpoint inhibitors (ICI). We assessed the impact of ATB and/or PPI use on the efficacy and safety of ICI.MethodsTwo hundred twelve patients treated with anti-PD1 ICI for non-small cell lung carcinoma, melanoma, upper airway & digestive tract carcinoma or renal cell carcinoma were retrospectively included. Patients having received ATB within 60 days before ICI initiation were included in the ATB+ group. Patients having received PPI within 30 days before ICI initiation were included in the PPI+ group. Four groups were thus considered: ATB-/PPI-, ATB+/PPI-, ATB-/PPI+, ATB+/PPI+. Response rate was assessed by RECIST v1.1. Overall survival (OS), progression-free survival (PFS) and adverse events, recorded using Common Terminology Criteria for Adverse Events Version 5, were compared using inverse probability of treatment weighting to account for selection bias.ResultsPFS at 6 months was 56.7 %, 95%CI (49.6%; 63.2%) and 47.2 %, 95%CI (39.8%;54.1%) at 12 months. OS was 81.6%, 95%CI (75.6%; 86.2%) at 6 months, and 69.4%, 95%CI (61.9%;75.7%) at 12 months. Compared to ATB-/PPI- group, PFS was lower for the ATB+/PPI- group [Hazard ratio (HR) 1.90, 95%CI (1.41;2.57)] and the ATB-/PPI+ group [HR 1.51, 95%CI (1.11;2.05)], and lowest in the ATB+/PPI+ group [HR 3.65, 95%CI (2.75;4.84)]. For OS, the use of ATB alone or PPI alone or in combination was a risk factor for death, with each increasing HR values by a similar magnitude, and the combination of ATB and PPI did not increase risk further. AEs were observed in 78 cases (36.8%) with no significant impact of ATB or PPI use.ConclusionsThis study reveals that ATB and/or PPI use can alter response to anti-PD1 ICI, and the prognosis of cancer patients. The microbiota mechanisms involved in the response to ICI should be investigated to optimize patient management.

INTRODUCTION AND OBJECTIVE:Horseshoe kidneys are uncommon with an estimated incidence of approximately 1 in 500 persons. Horseshoe kidneys are characterized by arrested developmental ascent and are...

INTRODUCTION AND OBJECTIVE:Pelvic kidneys are uncommon with an estimated incidence of approximately 1 in 3,000 persons. Pelvic kidneys are characterized by arrested renal developmental ascent in th...

Post Extreme Adaptive-Optics (ExAO) spectro-interferometers design allows high contrast imaging with an inner working angle down to half the theoretical angular resolution of the telescope. This regime, out of reach for conventional ExAO imaging systems, is obtained thanks to the interferometric recombination of multiple sub-apertures of a single telescope, using single mode waveguides to remove speckle noise. The SCExAO platform at the Subaru telescope hosts two instruments with such design, coupled with a spectrograph. The FIRST instrument operates in the Visible (600-800nm, R~400) and is based on pupil remapping using single-mode fibers. The GLINT instrument works in the NIR (1450-1650nm, R~160) and is based on nulling interferometry. We present here how these photonic instruments have the unique capability to simultaneously do high contrast imaging and be included in the wavefront sensing architecture of SCExAO.

Inflammation has been well recognized as one of the main drivers of atherosclerosis development and therefore cardiovascular diseases (CVDs). It has been shown that several chemokines, small 8 to 12 kDa cytokines with chemotactic properties, play a crucial role in the pathophysiology of atherosclerosis. Chemokines classically mediate their effects by binding to G-protein-coupled receptors called chemokine receptors. In addition, chemokines can also bind to atypical chemokine receptors (ACKRs). ACKRs fail to induce G-protein-dependent signalling pathways and thus subsequent cellular response, but instead are able to internalize, scavenge or transport chemokines. In this review, we will give an overview of the current knowledge about the involvement of ACKR1–4 in CVDs and especially in atherosclerosis development. In the recent years, several studies have highlighted the importance of ACKRs in CVDs, although there are still several controversies and unexplored aspects that have to be further elucidated. A better understanding of the precise role of these atypical receptors may pave the way towards novel and improved therapeutic strategies.

International audience; Objectives: This study hypothesized that the association of D-dimer blood level and several clinical items in a new risk score could predict the absence of atrial thrombus.Background: Symptomatic and drug resistant atrial fibrillation (AF) can be treated by catheter ablation. The procedure-related risk of thromboembolism is limited by the pre-operative use of transesophageal echocardiography (TEE) to detect atrial thrombi.Methods: Patients admitted for catheter ablation of AF (n = 2,494) were prospectively included in a multicenter study. TEE was systematically performed before the procedure to search for atrial thrombus (primary endpoint). D-dimer level, CHADS2 score, left ventricular ejection fraction, pre-operative anticoagulation regimen, and medical history were collected. A logistic regression model was used to identify factors associated with the presence of atrial thrombus (hypertension, history of stroke, heart failure, D-dimer level >270 ng/ml). These factors were aggregated in a new score called atrial thrombus exclusion (ATE).Results: The incidence of atrial thrombus was 1.92%. CHADS2 score and D-dimer level were significantly associated with atrial thrombus (p < 0.0001 and p < 0.0001, respectively). A zero CHADS2 score failed to exclude all atrial thrombi (5 false negatives; sensitivity: 89.58%, specificity: 52.2%). No false negative was found with a zero ATE score, which had a specificity of 37% and a higher sensitivity (100%) than the CHADS2 score (p < 0.031) to predict the absence of intra-atrial thrombi on TEE. Conversely, the positive predictive value was poor, and the ATE score should not be used to conclude a positive diagnosis of thrombus.Conclusions: An ATE score of zero was strongly associated with the absence of atrial thrombus. This new score could be useful to rule out a diagnosis of atrial thrombus before catheter ablation of AF.

Introduction Childhood otitis media with effusion (OME) is a frequent disease often misunderstood by parents. Information on the Internet is of variable quality and readability. The aim of this study was to measure the quality and readability of French websites related to OME. Material and methods An advanced Google search was conducted using the terms “Otite sero-muqueuse OR Otite sereuse”. Quality was assessed on DISCERN criteria. Readability was assessed using Flesch Reading Ease Scoring (FRES), Flesch-Kincaid Grade Level (FKGL), the Simple Measure of Gobbledygook (SMOG) and a Fry graph. Medians and standard deviations were calculated. Correlation between quality and readability was assessed on Spearman r coefficient. Results The first ten websites meeting inclusion and exclusion criteria were evaluated. One had been updated during the last 12 months. Median DISCERN score was 49 ± 13.7/80. Median FRES score was 46 ± 9.5/100. Median USA grade-level estimated by FKGL and SMOG respectively was 11 ± 1.7 and 12 ± 1.5. Six websites had Fry score > 12. One website showed high quality. One had a readability score in the target range (below 9th grade reading level (age 14–15)) according to FRES and FKGL. A suggestive correlation was found between lower SMOG readability and higher quality: r = 0.72 (P = 0.024). Three websites followed the most recent scientific guidelines. Conclusion Online information about OME was of variable quality and readability. Good quality information tended to be less easily understandable by parents.

Finding programming errors is one of the major challenges in software development. Formal methods such as model checking have become a popular approach to address this problem because of their guarantees about error status. However, one of the greatest challenges is to have correct information about complex internal details such as mem- ory, registers, and system state. In this paper we describe the C-SMC tool and methodology developed to find programming errors in C pro- grams by leveraging statistical model checking and runtime information. Our prototype shows that our approach can complement many existing software verification tools.

Background: Extrinsic compression of the ureter can result from multiple different malignancies, typically in the presence of known or disseminated disease. Rarely, hydroureteronephrosis and flank pain can occur as the presenting sign and symptom of lymphoma. In this study, we present two cases of primary ureteral obstruction in patients without a prior diagnosis of lymphoma and without bulky retroperitoneal lymphadenopathy. Case Presentation: Case #1 was a healthy 58-year-old man who presented with acute left flank pain. He was found to have left hydroureteronephrosis secondary to a proximal periureteral mass. Diagnostic ureteroscopy demonstrated this to be an extrinsic compression on the ureter and preoperative imaging was negative aside from one enlarged periaortic node. Laparoscopic ureterolysis and biopsy were remarkable for periureteral dystrophic tissue concerning for lymphoma. Case #2 was a 47-year-old woman with a solitary kidney secondary to prior left nephrectomy who presented with hydronephrosis of her solitary kidney and acute kidney injury. Retrograde pyelogram showed high-grade obstruction at the junction of the mid- and distal ureter. Periureteral thickening was noted, but no definitive masses were seen on cross-sectional imaging. Robotic ureterolysis showed dense fibrosis around the ureter. Pathology report from Cases #1 and #2 were both remarkable for marginal zone lymphoma and both patients received bendamustine and rixuximab with resolution of ureteral obstruction and their lymphoma. Conclusion: Ureteral compression as the primary presentation of periureteral lymphoma is a rare but important etiology of extrinsic malignant ureteral obstruction. These cases emphasize that malignant obstruction can occur even in the absence of disseminated disease.

FIRST (Fibered Imager foR a Single Telescope instrument) is a post-AO instrument that enables high contrast imaging and spectroscopy at spatial scales below the diffraction limit. FIRST achieves sensitivity and accuracy by a unique combination of sparse aperture masking, spatial filtering by single-mode fibers and cross-dispersion in the visible. The telescope pupil is divided into sub-pupils by an array of microlenses, coupling the light into single-mode fibers. The output of the fibers are rearranged in a non redundant configuration, allowing the measurement of the complex visibility for every baseline over the 600-900 nm spectral range. A first version of this instrument is currently integrated to the Subaru Extreme AO bench (SCExAO). This paper focuses on the on-going instrument upgrades and testings, which aim at increasing the instrument's stability and sensitivity, thus improving the dynamic range. FIRSTv2's interferometric scheme is based on a photonic chip beam combiner. We report on the laboratory characterization of two different types of 5-input beam combiner with enhanced throughput. The interferometric recombination of each pair of sub-pupils is encoded on a single output. Thus, to sample the fringes we implemented a temporal phase modulation by pistoning the segmented mirrors of a Micro-ElectroMechanical System (MEMS). By coupling high angular resolution and spectral resolution in the visible, FIRST offers unique capabilities in the context of the detection and spectral characterization of close companions, especially on 30m-class telescopes., Comment: 7 pages, 5 figures, SPIE proceeding: Astronomical Telescopes + Instrumentation 2020

Chemical alloying is a powerful approach to tune the electronic structure of semiconductors and has led to the synthesis of ternary and quaternary two-dimensional (2D) dichalcogenide semiconductor alloys (e.g., MoSSe₂, WSSe₂, etc.). To date, most of the studies have been focused on determining the chemical composition by evaluating the optical properties, primarily via photoluminescence and reflection spectroscopy of these materials in the 2D monolayer limit. However, a comprehensive study of alloying in multilayer films with direct measurement of electronic structure, combined with first-principles theory, is required for a complete understanding of this promising class of semiconductors. We have combined first-principles density functional theory calculations with experimental characterization of MoS_(2(1-x))Se_(2x) (where x ranges from 0 to 1) alloys using X-ray photoelectron spectroscopy to evaluate the valence and conduction band edge positions in each alloy. Moreover, our observations reveal that the valence band edge energies for molybdenum sulfide/selenide alloys increase as a function of increasing selenium concentration. These experimental results agree well with the results of density functional theory calculations showing a similar trend in calculated valence band edges. Our studies suggest that alloying is an effective technique for tuning the band edges of transition-metal dichalcogenides, with implications for applications such as solar cells and photoelectrochemical devices.

Introduction: Roughly 70% of prostatectomies were accompanied by pelvic lymph node dissection (PLND) in 2010–2011.1 PLND can provide staging information that may help further determine ext...

Background. Fungemia due to obstructive urinary tract fungal ball is exceedingly rare. These patients often have multiple predisposing conditions, including diabetes or antimicrobial exposure. While candiduria can be relatively common in this population, urinary tract fungal balls are a rare entity. Hospitalists should be aware of this rare complication in patients presenting with funguria. Case Presentation. We present a case of a 44-year-old male with type II diabetes, chronic hepatitis C secondary to injection drug use, and chronic kidney disease who developed a urinary tract fungal ball leading to fungemia and subsequent bilateral chorioretinitis, additionally complicated by emphysematous cystitis and pyelonephritis. Additional invasive treatment options beyond typical antifungals are often required in the case of urinary tract fungal ball, and in this case, bilateral nephrostomy tubes and micafungin were employed. Hospital course was complicated by C. tropicalis fungemia with subsequent bilateral fungal chorioretinitis on dilated fundus exam. This was effectively treated with cyclogyl and prednisolone drops along with bilateral voriconazole injections. Follow-up imaging and cultures showed resolution of fungemia, urinary tract masses, and chorioretinal infiltrates; however, recurrent polymicrobial UTIs continue to be an issue for this patient. Conclusions. Special multidisciplinary management is required in the treatment of urinary tract fungal balls with subsequent fungemia, including nephrostomy tubes, antifungal irrigation, ureterorenoscopy, and more powerful antifungals such as amphotericin B and 5-flucytosine. This management draws from a myriad of specialties, including urology, infectious disease, and interventional radiology. Additionally, the literature has demonstrated that only approximately half of patients with fungemia receive an ophthalmologic evaluation. Ophthalmologic and urologic cooperation is essential in the case of obstructive uropathy leading to fungemia as the obstructive uropathy must be relieved and these patients should receive a dilated fundus exam.

Photoelectrocatalysis of the oxygen evolution reaction remains a primary challenge for development of tandem-absorber solar fuel generators due to the lack of a photoanode with broad solar spectrum utilization, a large photovoltage, and stable operation. Bismuth vanadate with a 2.4–2.5 eV band gap has shown the most promise becauses its photoactivity down to 0.4 V vs RHE is sufficiently low to couple to a lower-gap photocathode for fuel synthesis. Through development of photoanodes based on the FeWO4 structure, in particular, Fe-rich variants with addition of about 6% Bi, we demonstrate the same 0.4 V vs RHE turn-on voltage with a 2 eV band gap metal oxide, enabling a 2-fold increase in the device efficiency limit. Combinatorial exploration of materials composition and processing facilitated synthesis of n-type variants of this typical p-type semiconductor that exhibit much higher photoactivity than previous implementations of FeWO4 in solar photochemistry. The photoanodes are particularly promising for s...

Single point incremental forming (SPIF) has several advantages over traditional forming, such as the high formability attainable by the material. Different hypotheses have been proposed to explain this behavior, but there is still no straightforward relation between the particular stress and strain state induced by SPIF and the material degradation leading to localization and fracture. A systematic review of the state of the art about formability and damage in SPIF is presented and an extended Gurson–Tvergaard–Needleman (GTN) model was applied to predict damage in SPIF through finite element (FE) simulations. The line test was used to validate the simulations by comparing force and shape predictions with experimental results. To analyze the failure prediction, several simulations of SPIF cones at different wall angles were performed. It is concluded that the GTN model underestimates the failure angle on SPIF due to wrong coalescence modeling. A physically-based Thomason coalescence criterion was then used leading to an improvement on the results by delaying the onset of coalescence.

Harvesting nonequilibrium hot carriers from plasmonic-metal nanostructures offers unique opportunities for driving photochemical reactions at the nanoscale. Despite numerous examples of hot electron-driven processes, the realization of plasmonic systems capable of harvesting hot holes from metal nanostructures has eluded the nascent field of plasmonic photocatalysis. Here, we fabricate gold/p-type gallium nitride (Au/p-GaN) Schottky junctions tailored for photoelectrochemical studies of plasmon-induced hot-hole capture and conversion. Despite the presence of an interfacial Schottky barrier to hot-hole injection of more than 1 eV across the Au/p-GaN heterojunction, plasmonic Au/p-GaN photocathodes exhibit photoelectrochemical properties consistent with the injection of hot holes from Au nanoparticles into p-GaN upon plasmon excitation. The photocurrent action spectrum of the plasmonic photocathodes faithfully follows the surface plasmon resonance absorption spectrum of the Au nanoparticles and open-circuit...

Background: The pericardial adipose tissue (AT) contains a high density of lymphoid clusters. It is unknown whether these clusters play a role in post–myocardial infarction (MI) inflammatory responses and cardiac outcome. Methods: Lymphoid clusters were examined in epicardial AT of humans with or without coronary artery disease. Murine pericardial lymphoid clusters were visualized in mice subjected to coronary artery ligation. To study the relevance of pericardial clusters during inflammatory responses after MI, we surgically removed the pericardial AT and performed B-cell depletion and granulocyte-macrophage colony-stimulating factor blockade. Leukocytes in murine hearts, pericardial AT, spleen, mediastinal lymph nodes, and bone marrow were quantified by flow cytometry. Cannabinoid receptor CB2 (CB2 –/– ) mice were used as a model for enhanced B-cell responses. The effect of impaired dendritic cell (DC) trafficking on pericardial AT inflammatory responses was tested in CCR7 –/– mice subjected to MI. Cardiac fibrosis and ventricular function were assessed by histology and echocardiography. Results: We identified larger B-cell clusters in epicardial AT of human patients with coronary artery disease in comparison with controls without coronary artery disease. Infarcted mice also had larger pericardial clusters and 3-fold upregulated numbers of granulocyte-macrophage colony-stimulating factor–producing B cells within pericardial AT, but not spleen or lymph nodes. This was associated with higher DC and T-cell counts in pericardial AT, which outnumbered DCs and T cells in lymph nodes. Analysis of DC maturation markers, tracking experiments with fluorescently labeled cells, and use of CCR7-deficient mice suggested that activated DCs migrate from infarcts into pericardial AT via CCR7. B-cell depletion or granulocyte-macrophage colony-stimulating factor neutralization inhibited DC and T-cell expansion within pericardial AT, and translated into reduced bone marrow granulopoiesis and cardiac neutrophil infiltration 3 days after MI. The relevance of the pericardial AT in mediating all these effects was confirmed by removal of pericardial AT and ex vivo coculture with pericardial AT and granulocyte progenitors. Finally, enhanced fibrosis and worsened ejection fraction in CB2 –/– mice were limited by pericardial AT removal. Conclusions: Our findings unveil a new mechanism by which the pericardial AT coordinates immune cell activation, granulopoiesis, and outcome after MI.

Polymer composite materials are being increasingly used in primary load-bearing structures in several advanced industrial fields such as aerospace vessels, railway wagons and mega-scaled wind turbines where detection of subcritical damage initiation can significantly reduce safety issues and maintenance costs. It is therefore crucial to inspect these composite structures in order to assess their structural health and to ensure their integrity. Non-destructive testing techniques (NDT) are used for this purpose, making it possible to monitor mechanical damage of composite materials under in situ or ex situ service conditions. This paper reviews the capabilities of the most common NDT techniques used to inspect the integrity of composite materials. Each technique has a detection potential and cannot allow a full diagnosis of the mechanical damage state of the material. Thus, depending on the occurring damage mechanism and the conditions of use, one technique will be preferred over another, or several techniques should be combined to improve the diagnosis of the damage state of the structures.

BACKGROUND: The purpose of this study was to investigate how 8-isoprostanes, used as a marker of airway oxidative stress, were related to sinus disease and asthma. METHODS: We analyzed samples and data from two separate studies, one investigating sinonasal disease in asthma, the other investigating the effect of BMI on airway disease. We measured airway (nasal lavage) 8-isoprostanes and investigated the relationship with measures of sinus and asthma symptoms, asthma control and lung function. RESULTS: The study of people with sinonasal disease and poorly controlled asthma included 48 obese, 31 overweight and 23 lean participants. In multivariate analysis, nasal lavage 8-isoprostane levels increased with increasing BMI (p

People with chronic behavioural and physical health conditions have higher healthcare costs and mortality rates than patients with chronic physical conditions alone. As a result, there has been promotion of integrated care for this group. It is important to train primary care residents to practice in integrated models of care with interprofessional teams and to evaluate the effectiveness of integrated care models to promote high-quality care for this at-risk group. We implemented an integrated, interprofessional care management programme for adults with chronic mental and physical health needs as part of a curriculum for family medicine and family medicine psychiatry residents. We then evaluated the clinical effectiveness of this programme by describing participants' healthcare utilisation patterns pre- and post-enrolment. Patients enrolled in the programme were approximately 60-70% less likely to utilise the emergency room and 50% less likely to be admitted to the hospital after enrolment in the programme compared to before enrolment. The odds of individual attendance at outpatient primary care and mental health visits improved after enrolment. In the context of the implementation of integrated behavioural and physical healthcare in primary care, this interprofessional care management programme reduced emergency department utilisation and hospitalisations while improving utilisation of primary care and psychiatry outpatient care. Further studies should focus on replication of this model to further discern the model's cost-savings and health promotion effects.

Background The Accreditation Council for Graduate Medical Education Milestone Project was implemented in 2014 to standardize assessments and progression of residents. While it is recommended that milestones not be used as tools for direct assessments of resident competency, many programs have used or adapted milestone tools for this purpose. Objective We sought to explore use of the most frequent milestone level at which a resident was evaluated (ie, the mode), and compared this to the standard practice of using the arithmetic mean for summarizing performance. Methods We reviewed all Family Medicine Milestone evaluations from 1 program for the first 2 academic years of milestone implementation. Mean and mode scores were calculated across 24 unique residents, 841 evaluation forms, and 5897 measurements. The proportion of overestimation errors (where the mean is at least 0.5 larger than the mode) and underestimation errors (where the mean is at least 0.5 less than the mode) were then compared across resident training year and subcompetency. Results For the 24 residents, an estimation error occurred in 175 of 792 of the comparisons (22%). Of these errors, 118 (67%) were overestimation errors. First-year residents accounted for 55% (96 of 175) of all estimation errors. All subcompetencies had some estimation errors, with 6 having greater than 5%. Conclusions If the trend for using the milestones as stand-alone assessment tools is to continue, aggregating data by using frequency distributions and mode would be a more stable and appropriate approach given their nominal or, at best, ordinal nature.

Los sarcomas asociados a sitios de inoculación son neoplasias de origen mesenquimático que aparecen en las regiones corporales utilizadas rutinariamente para la aplicación de vacunas u otros inóculos. Con el objetivo de caracterizar estas neoplasias se seleccionaron 117 tumores diagnosticados como sarcomas posinoculación. Se realizaron estudios histopatológicos e inmunohistoquímicos que permitieron reclasificar los diferentes sarcomas hallados y establecer el porcentaje de células proliferantes. Además, se consideraron los datos demográficos y se realizaron encuestas a los médicos veterinarios para conocer la evolución de los pacientes. El diagnóstico más frecuente fue el de fibrosarcoma (87,18%). También, se encontraron, en menor proporción, otros tumores como: sarcomas pleomórficos (HFM), osteosarcomas extraesqueléticos y mixosarcomas. El grado histológico más frecuente fue el II y la mayoría presentó abundante inflamación. El promedio de células proliferantes alcanzó el 50,12%. La edad de los pacientes al momento del diagnóstico fue mayor que la informada por otros autores. Si bien los sarcomas asociados a sitios de inoculación en la República Argentina comparten características histopatológicas y clínicas con aquellos informados en otros países, existen diferencias vinculadas a la edad al momento del diagnóstico, a la presentación de las recidivas y al tiempo de sobrevida, entre otras características., Feline injectionsite sarcomas are neoplasms of mesenchymal origin frequently found in sites of the body routinely used for inoculation of vaccines and other drugs. With the aim of characterizing these neoplasms, 117 postinoculation sarcomas were selected and analyzed. Histopathological and immunohistochemical techniques were performed to reclassify different sarcomas and determine cellular proliferation percentages. In addition, demographic data were considered, and surveys were conducted to obtain information about the clinical followup of patients. Of all tumors analyzed, fibrosarcoma was the most frequently diagnosed (87.18%), followed by pleomorphic sarcomas (HFM), extra skeletal osteosarcomas and mixosarcomas. The most frequent histological grade was type II which was associated with great inflammation. Cell proliferation percentage of these tumors was 50.12%. The average age of diagnosis for these sarcomas was higher than that reported by other authors. Although in Argentina injectionsite sarcomas shared histopathological and clinical characteristics with those reported in other countries, differences such as the age in the moment of diagnosis, recurrence and survival were found., Facultad de Ciencias Veterinarias

Summary Background Since the 1918 influenza pandemic, non-randomised studies and small clinical trials have suggested that convalescent plasma or anti-influenza hyperimmune intravenous immunoglobulin (hIVIG) might have clinical benefit for patients with influenza infection, but definitive data do not exist. We aimed to evaluate the safety and efficacy of hIVIG in a randomised controlled trial. Methods This randomised, double-blind, placebo-controlled trial was planned for 45 hospitals in Argentina, Australia, Denmark, Greece, Mexico, Spain, Thailand, UK, and the USA over five influenza seasons from 2013–14 to 2017–18. Adults (≥18 years of age) were admitted for hospital treatment with laboratory-confirmed influenza A or B infection and were randomly assigned (1:1) to receive standard care plus either a single 500-mL infusion of high-titre hIVIG (0·25 g/kg bodyweight, 24·75 g maximum; hIVIG group) or saline placebo (placebo group). Eligible patients had a National Early Warning score of 2 points or greater at the time of screening and their symptoms began no more than 7 days before randomisation. Pregnant and breastfeeding women were excluded, as well as any patients for whom the treatment would present a health risk. Separate randomisation schedules were generated for each participating clinical site using permuted block randomisation. Treatment assignments were obtained using a web-based application by the site pharmacist who then masked the solution for infusion. Patients and investigators were masked to study treatment. The primary endpoint was a six-category ordinal outcome of clinical status at day 7, ranging in severity from death to resumption of normal activities after discharge. The choice of day 7 was based on haemagglutination inhibition titres from a pilot study. It was analysed with a proportional odds model, using all six categories to estimate a common odds ratio (OR). An OR greater than 1 indicated that, for a given category, patients in the hIVIG group were more likely to be in a better category than those in the placebo group. Prespecified primary analyses for safety and efficacy were based on patients who received an infusion and for whom eligibility could be confirmed. This trial is registered with ClinicalTrials.gov , NCT02287467 . Findings 313 patients were enrolled in 34 sites between Dec 11, 2014, and May 28, 2018. We also used data from 16 patients enrolled at seven of the 34 sites during the pilot study between Jan 15, 2014, and April 10, 2014. 168 patients were randomly assigned to the hIVIG group and 161 to the placebo group. 21 patients were excluded (12 from the hIVIG group and 9 from the placebo group) because they did not receive an infusion or their eligibility could not be confirmed. Thus, 308 were included in the primary analysis. hIVIG treatment produced a robust rise in haemagglutination inhibition titres against influenza A and smaller rises in influenza B titres. Based on the proportional odds model, the OR on day 7 was 1·25 (95% CI 0·79–1·97; p=0·33). In subgroup analyses for the primary outcome, the OR in patients with influenza A was 0·94 (0·55–1·59) and was 3·19 (1·21–8·42) for those with influenza B (interaction p=0·023). Through 28 days of follow-up, 47 (30%) of 156 patients in the hIVIG group and in 45 (30%) of 152 patients in the placebo group had the composite safety outcome of death, a serious adverse event, or a grade 3 or 4 adverse event (hazard ratio [HR] 1·06, 95% CI 0·70–1·60; p=0·79). Six (4%) patients in the hIVIG group and five (3%) in the placebo group died, but these deaths were not necessarily related to treatment. Interpretation When administered alongside standard care (most commonly oseltamivir), hIVIG was not superior to placebo for adults hospitalised with influenza infection. By contrast with our prespecified subgroup hypothesis that hIVIG would result in more favourable responses in patients with influenza A than B, we found the opposite effect. The clinical benefit of hIVIG for patients with influenza B is supported by antibody affinity analyses, but confirmation is warranted. Funding NIAID and NIH. Partial support was provided by the Medical Research Council (MRC_UU_12023/23) and the Danish National Research Foundation.

Photoelectrochemical, photoelectrical and ultra-fast pump-probe studies elucidate the generation and dynamics of plasmonic hot-holes and suggest new opportunities for hot-carrier optoelectronic devices

IPv6 Segment Routing is a recent IPv6 extension that is generating a lot of interest among researchers and in industry. Thanks to IPv6 SR, network operators can better control the paths followed by packets inside their networks. This provides enhanced traffic engineering capabilities and is key to support Service Function Chaining (SFC). With SFC, an end-to-end service is the composition of a series of in-network services. Simple services such as NAT, accounting or stateless firewalls can be implemented on a per-packet basis. However, more interesting services like transparent proxies, transparent compression or encryption, transcoding, etc. require functions that operate on the bytestream. In this paper, we extend the IPv6 implementation of Segment Routing in the Linux kernel to enable network functions that operate on the bytestream and not on a per-packet basis. Our SRv6Pipes enable network architects to design end-to-end services as a series of in-network functions. We evaluate the performance of our implementation with different microbenchmarks.

The outcomes of the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) trial have unequivocally proven that inflammation is a key driver of atherosclerosis and that targeting inflammation, in this case by using an anti-interleukin-1β antibody, improves cardiovascular disease (CVD) outcomes. This is especially true for CVD patients with a pro-inflammatory constitution. Although CANTOS has epitomized the importance of targeting inflammation in atherosclerosis, treatment with canakinumab did not improve CVD mortality, and caused an increase in infections. Therefore, the identification of novel drug targets and development of novel therapeutics that block atherosclerosis-specific inflammatory pathways and exhibit limited immune-suppressive side effects, as pursued in our collaborative research centre, are required to optimize immunotherapy for CVD. In this review, we will highlight the potential of novel immunotherapeutic targets that are currently considered to become a future treatment for CVD.

8578 Background: TETs are rare and potentially aggressive malignancies with high associated prevalence of autoimmune disorders (AIDs). The pleura is the main metastatic site at relapse, referred as Masaoka-Koga stage (MK) IVa. The benefit of surgical management is unknown, so we have collected outcomes of patients with MK IVa TETs in a large prospective database. Methods: RYTHMIC (Réseau tumeurs THYMiques et Cancer) is a French nationwide network mandated to systematically discuss every case of TETs. The database, hosted by IFCT (Intergroupe Francophone de Cancérologie Thoracique), prospectively includes all consecutive pts with a diagnosis of TET discussed in RYTHMIC national or regional tumor boards. We analyzed epidemiologic, clinical and pathological characteristics of patients (pts) with MK IVa TETs. Results: From January 2012 to December 2019, 2909 pts were included in the database, including 182 MK IVa (6.2%). The median age at diagnosis was 63.5 (range 9 to 91). 58/182 (32%) pts reported AIDs, 76% myasthenia gravis. 129/182 pts had synchronous pleural metastasis. 118/182 (65%) tumors were resected, of them 10 (8.4%) had only pericardial metastases. Thymoma (T) B2 rate was 35.6%, B3 17.8% and thymic carcinoma (TC) 13.5%. Induction chemotherapy (CT) was given in 46 (39%) T and 10 (8%) TC with response rate of 50% and 70% respectively. Thymectomy was performed in addition to pleurectomy in 44 pts (37.2%), pericardiectomy in 68 (57.6%), lung resection in 80 (67.8%) or pneumonectomy in 15 (12.7%). Node resection was performed in 57.6% (n = 67), 12 (18%) were positive. The complete resection rate assessed by surgeons was 57% with a median of 15 (0 to 28) resected pleural metastasis. Intrapleural chemotherapy was added for 19 (16%) pts. No mortality was reported 90 days after surgery procedure. Median follow-up was 36 months. Pleural recurrence was seen in 47 (72%) pts. Median disease-free survival (DFS) was 39 vs 16 months in resected vs not resected tumors (p < 0.0001), 5-years overall survival (OS) was 88 vs 66% (p = 0.28), respectively. Risk of relapse decreased by 60% with surgery (HR = 0.4, 95CI (0.25-0.62); p < 0.0001). Conclusions: The prevalence of MK IVa in our cohort was 6.2%. Surgery appears to be a safe and valid option for pts with MK IVa TET at diagnosis.

Background Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis ( IE ). The purpose of the present study was both to analyze the risk factors for in‐hospital death, which complicates surgery for IE , and to create a mortality risk score based on the results of this analysis. Methods and Results Outcomes of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in‐hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty‐six (15.5%) patients died postsurgery. BMI >27 kg/m 2 (odds ratio [ OR ], 1.79; P =0.049), estimated glomerular filtration rate OR , 3.52; P IV ( OR , 2.11; P =0.024), systolic pulmonary artery pressure >55 mm Hg ( OR , 1.78; P =0.032), and critical state ( OR , 2.37; P =0.017) were independent predictors of in‐hospital death. A scoring system was devised to predict in‐hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734–0.822). The score performed better than 5 of 6 scoring systems for in‐hospital death after cardiac surgery that were considered. Conclusions A simple scoring system based on risk factors for in‐hospital death was specifically created to predict mortality risk postsurgery in patients with IE .

Purpose – Numerical simulation of the single point incremental forming (SPIF) processes can be very demanding and time consuming due to the constantly changing contact conditions between the tool and the sheet surface, as well as the nonlinear material behaviour combined with non-monotonic strain paths. The purpose of this paper is to propose an adaptive remeshing technique implemented in the in-house implicit finite element code LAGAMINE, to reduce the simulation time. This remeshing technique automatically refines only a portion of the sheet mesh in vicinity of the tool, therefore following the tool motion. As a result, refined meshes are avoided and consequently the total CPU time can be drastically reduced. Design/methodology/approach – SPIF is a dieless manufacturing process in which a sheet is deformed by using a tool with a spherical tip. This dieless feature makes the process appropriate for rapid-prototyping and allows for an innovative possibility to reduce overall costs for small batches, since the process can be performed in a rapid and economic way without expensive tooling. As a consequence, research interest related to SPIF process has been growing over the last years. Findings – In this work, the proposed automatic refinement technique is applied within a reduced enhanced solid-shell framework to further improve numerical efficiency. In this sense, the use of a hexahedral finite element allows the possibility to use general 3D constitutive laws. Additionally, a direct consideration of thickness variations, double-sided contact conditions and evaluation of all components of the stress field are available with solid-shell and not with shell elements. Additionally, validations by means of benchmarks are carried out, with comparisons against experimental results. Originality/value – It is worth noting that no previous work has been carried out using remeshing strategies combined with hexahedral elements in order to improve the computational efficiency resorting to an implicit scheme, which makes this work innovative. Finally, it has been shown that it is possible to perform accurate and efficient finite element simulations of SPIF process, resorting to implicit analysis and continuum elements. This is definitively a step-forward on the state-of-art in this field.