Search

Transition metal fluoride (TMF) conversion-type cathodes promise up to 4 times higher gravimetric energy densities compared to those of common intercalation-type cathodes. However, TMF cathodes demonstrate sluggish kinetics, poor efficiencies, and incompatibility with many liquid electrolytes. In this work, coevaporated heterostructured iron and lithium fluoride (Fe-LiF) cathodes are investigated in thin-film solid-state batteries with a LiPON electrolyte and a lithium metal anode. The cells were cycled 2000 times at a cycling rate of 6C. They show a gradual improvement in voltaic efficiency (37-53%) and specific capacity (146-216 mAh/g) during cycling. After 2000 cycles, the cathode capacity reaches 480 mAh/g at a cycling rate of C/3.6, close to its theoretical capacity of 498 mAh/g, at room temperature conditions. This capacity gain is correlated with an observed electrochemically activated nanorestructuring of the cathode, characterized by cycling-induced coarsening (from 2.8 to 4.2 nm) of the metallic iron phase and its accumulation near the current collector interface, as well as lithium fluoride phase accumulation near the LiPON interface.

In the concept of anode-free lithium-ion batteries, cells are manufactured with a bare anode current collector where the lithium metal anode is electrochemically formed from the lithium-containing cathode during the first charge cycle. While this concept has many attractive aspects from a manufacturing and energy density standpoint, stable plating and stripping remain challenging. We have investigated gold, platinum, and amorphous carbon as seed layers placed between the copper current collector and the lithium phosphorus oxynitride thin-film solid electrolyte. These layers guide lithium nucleation and improve the plating and stripping dynamics. All seed layers facilitate reversible lithium plating and stripping even at high current densities up to 8 mA cm -2 . Of particular note is the amorphous carbon seed layer, which allowed a significant reduction in plating potential from 300 mV to as low as 50 mV. These results underscore the critical role of seed layers in improving the efficiency of anode-free solid-state batteries and open the door to simplified manufacturing of anode-free battery designs.

The power capability of Li-ion batteries has become increasingly limiting for the electrification of transport on land and in the air. The specific power of Li-ion batteries is restricted to a few thousand W kg -1 due to the required cathode thickness of a few tens of micrometers. We present a design of monolithically-stacked thin-film cells that has the potential to increase the power ten-fold. We demonstrate an experimental proof-of-concept consisting of two monolithically stacked thin-film cells. Each cell consists of a silicon anode, a solid-oxide electrolyte, and a lithium cobalt oxide cathode. The battery can be cycled for more than 300 cycles between 6 and 8 V. Using a thermo-electric model, we predict that stacked thin-film batteries can achieve specific energies >250 Wh kg -1 at C-rates above 60, resulting in a specific power of tens of kW kg -1 needed for high-end applications such as drones, robots, and electric vertical take-off and landing aircrafts., (© 2023. The Author(s).)

SGLT2 inhibitors have been shown to have a role in the management of heart failure in patients with type 2 diabetes mellitus, but there is a risk of exacerbation when discontinued., Competing Interests: Author disclosures The authors report no actual or potential conflicts of interest with regard to this article., (Copyright © 2021 Frontline Medical Communications Inc., Parsippany, NJ, USA.)

Background: Advancements in diabetes technology now allow insulin pump and continuous glucose monitor (CGM) technology to be a part of usual US Department Veterans Affairs (VA) clinical care. The automated insulin pump (AIP) delivers insulin automatically based on CGM readings. In randomized clinical trials the closed-loop system has shown to improve glycemic control in children and younger adults with type 1 diabetes mellitus (T1DM) while preventing hypoglycemia. However, its safety and efficacy is less well known in older veterans with T1DM. In this VA pilot study, we aimed to assess AIP technology in the real world of an older population of veterans with T1DM followed in the outpatient setting., Methods: Thirty-seven patients with T1DM new to AIP seen at the Malcom Randall VA Medical Center in Gainesville, Florida, were evaluated between March and December of 2018 on an Medtronic Minimed 670G Insulin Pump System. We collected demographic as well as clinical data before and after the initiation of AIP, including standard insulin pump/CGM information (sensor wear, time in target glucose range, time in automated mode, other)., Results: At the time of the initiation of AIP, the mean (SD) age of patients was 59.1 (14.4) years; 35 identified as male and 2 as female. The mean (SD) duration of T1DM was 25.3 (12.0) years. Patients transitioned from either insulin injections or other non-AIP pump to AIP safely-there was no increase in hypoglycemia, and the mean (SD) hemoglobin A 1c decreased from 7.6% (0.8) to 7.3% (0.8) by the second follow-up visit., Conclusion: In this real-world study, AIP use was both safe and viable as a tool for T1DM management with older veterans. This technology further engaged veterans in monitoring their blood sugars and achieving more optimal glycemic control. Future long-term, larger studies are much needed in this setting., Competing Interests: Author disclosures The authors report no actual or potential conflicts of interest with regard to this article., (Copyright © 2021 Frontline Medical Communications Inc., Parsippany, NJ, USA.)

A 67-year-old male was admitted with shortness of breath and diarrhea. His COVID-19 polymerase chain reaction test was positive, and he was found to be in acute heart failure. Troponin levels were elevated, echocardiogram showed ejection fraction of 24%, and his electrocardiogram was normal. Inflammatory markers were elevated. Further testing revealed suppressed thyroid-stimulating hormone and elevated free thyroxine (T4). Differential diagnosis at this point included possible myocarditis from the viral illness, exacerbation of heart failure from the viral infection or from thyrotoxicosis was considered. Patient's heart failure improved with initiation of heart failure therapies; however, biochemically, his thyroid function tests (TFTs) did not improve, despite empiric methimazole. Thyroid antibody tests were unremarkable. Thyroid ultrasound showed mildly enlarged thyroid gland with no increased vascularity and 5-mm bilateral cysts. Thyroid dysfunction was attributed to subacute thyroiditis from COVID-19, methimazole was tapered, and prednisone was initiated. The patient's TFTs improved. With the ongoing COVID-19 pandemic, it is imperative that clinicians keep a broad differential in individuals presenting with heart failure, and obtaining baseline TFTs may be reasonable. Rapid treatment of the underlying thyroiditis is important in these patients to improve the cardiovascular outcomes. In our experience, steroid therapy showed a rapid improvement in the TFTs.

This article reviews the significance of nutritional status in patients with cystic fibrosis (CF), and sheds light on the reasons behind the intense focus placed on perpetual weight gain and increased caloric intake by CF patients and their providers. The manuscript explores the potential mechanisms by which aberrant CFTR may contribute to increased resting energy expenditure (REE), and how correcting and potentiating its activity, possibly by reducing REE, among other intended and off-target effects, can contribute to weight gain in this patient population. The commentary also examines what is currently known about metabolic and vascular complications of obesity in patients with CF, and presents dietary, nutritional, pharmacologic and surgical approaches that may help obese patients with CF lose weight and build more lean body mass., (Copyright © 2019 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Mortality from collision with vehicles is the most visible impact of road traffic on wildlife. Mortality due to roads (hereafter road-kill) can affect the dynamic of populations of many species and can, therefore, increase the risk of local decline or extinction. This is especially true in Brazil, where plans for road network upgrading and expansion overlaps biodiversity hotspot areas, which are of high importance for global conservation. Researchers, conservationists and road planners face the challenge to define a national strategy for road mitigation and wildlife conservation. The main goal of this dataset is a compilation of geo-referenced road-kill data from published and unpublished road surveys. This is the first Data Paper in the BRAZIL series (see ATLANTIC, NEOTROPICAL, and BRAZIL collections of Data Papers published in Ecology), which aims make public road-kill data for species in the Brazilian Regions. The dataset encompasses road-kill records from 45 personal communications and 26 studies published in peer-reviewed journals, theses and reports. The road-kill dataset comprises 21,512 records, 83% of which are identified to the species level (n = 450 species). The dataset includes records of 31 amphibian species, 90 reptile species, 229 bird species, and 99 mammal species. One species is classified as Endangered, eight as Vulnerable and twelve as Near Threatened. The species with the highest number of records are: Didelphis albiventris (n = 1,549), Volatinia jacarina (n = 1,238), Cerdocyon thous (n = 1,135), Helicops infrataeniatus (n = 802), and Rhinella icterica (n = 692). Most of the records came from southern Brazil. However, observations of the road-kill incidence for non-Least Concern species are more spread across the country. This dataset can be used to identify which taxa seems to be vulnerable to traffic, analyze temporal and spatial patterns of road-kill at local, regional and national scales and also used to understand the effects of road-kill on population persistence. It may also contribute to studies that aims to understand the influence of landscape and environmental influences on road-kills, improve our knowledge on road-related strategies on biodiversity conservation and be used as complementary information on large-scale and macroecological studies. No copyright or proprietary restrictions are associated with the use of this data set other than citation of this Data Paper., (© 2018 The Authors. Ecology © 2018 The Ecological Society of America.)

The data set represents the first attempt at a large-scale inventory of non-volant mammals, with potential applications to performing macroecological studies, developing conservation strategies, and undertaking population and community ecology research, but also to evaluate the ecological consequences of fragmentation and defaunation. Our objectives for compiling these data were to summarize information about inventories of non-volant mammals in the critically important area of the Upper Paraná River Basin by focusing on species richness and index of frequency of occurrence and to identify gaps in knowledge regarding non-volant mammal communities in order to guide future sampling efforts. The data set comprises studies on communities of non-volant mammals from 52 locations covering more than 1,000 km 2 and comprises portion of four Brazilian states in the Upper Paraná River Basin. We listed 81 species of non-volant mammals distributed among 58 genera, 22 families, and 9 orders. Rodentia (28 species) was the richest order, followed by Carnivora (17 spp.) and Didelphimorphia (15 spp.). The richest family was Cricetidae (20 spp.), followed by Didelphidae (15 spp.), and Dasypodidae and Felidae (six spp.). Considering national conservation status, one species are considered endangered and 16 vulnerable. Considering global conservation status, 7 species are considered vulnerable, 10 are considered near threatened, and 6 are data deficient. According to the index of frequency of occurrence, Myrmecophaga tridactyla was the most frequent species, occurring at 88.64% of all sites, while 25 species were considered very restricted, occurring in just 2.56% of all sites. In general, the non-volant mammal fauna was composed of mainly very restricted (VR, 25 species) and localized species (L, 25 species), which account for 61.7% of the known species, while 38.3% are restricted (R, 8 species), common (C, 16 species), and widespread (W, 7 species). Seven marsupials and five small rodents had their distributions extended in the central-south of Brazil. All of these species are considered data deficient or threatened, which highlights the importance of these records. No copyright restrictions are associated with the use of this data set. Please cite this data paper when the data are used in publications. We also request that researchers and teachers inform us of how they are using the data., (© 2018 by the Ecological Society of America.)

Objectives: To examine whether simulation training enhanced self-efficacy of physicians and nurses who work in the outpatient setting to use electronic medical records, and whether the training changed their perceptions about the importance of electronic medical records (EMRs) in helping patients and improving patients' safety., Methods: Two-hundred and ninety-three physicians and 94 nurses participated in the study. Participants first attended two computer classroom training sessions on how to use EMRs. Subsequently, the participants attended simulation training and practiced application of EMRs while encountering standardized patients. They answered questionnaires on a seven-point Likert-type scale prior to and immediately after simulation training. The questionnaires assessed their perceptions about the importance of EMRs in helping patients and improving patients' safety and their confidence and preparedness level to use EMRs., Results: The overall self-efficacy of physicians and nurses to use EMRs increased after simulation training as compared to before simulation training. The physicians' and nurses' ratings about importance of EMRs to help patients' and improve patients' safety after simulation training were relatively unchanged compared to the ratings before simulation training. Additionally, participants described simulation training as exceptional, because it was an interactive learning opportunity to use EMRs within a simulated clinical setting with a simulated patient., Conclusions: Simulation training in the current study enhanced physicians' and nurses' level of self-confidence and preparedness to use EMRs. To train health care providers how to use EMRs, simulation training should be considered as an interactive and effective method of teaching prior to implementation of EMRs in medical institutions., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The completion of the Multicenter Silent Infarct Transfusion Trial demonstrated that children with pre-existing silent cerebral infarct and sickle cell anemia (SCA) who received regular blood transfusion therapy had a 58% relative risk reduction of infarct recurrence when compared to observation. However, the total benefit of blood transfusion therapy, as assessed by the parents, was not measured against the burden of monthly blood transfusion therapy. In this planned ancillary study, we tested the hypothesis that a patient centered outcome, health-related quality of life (HRQL), would be greater in participants randomly assigned to the blood transfusion therapy group than the observation group. A total of 89% (175 of 196) of the randomly allocated participants had evaluable entry and exit HRQL evaluations. The increase in Change in Health, measured as the child's health being better, was significantly greater for the transfusion group than the observation group (difference estimate = -0.54, P ≤ 0.001). This study provides the first evidence that children with SCA who received regular blood transfusion therapy felt better and had better overall HRQL than those who did not receive transfusion therapy., (© 2014 Wiley Periodicals, Inc.)

Unlabelled: Physical function and functional recovery are important aspects of the acute pain experience in children and adolescents in hospitalized settings. Measures of function related to pediatric acute pain do not exist currently, limiting understanding of recovery in youth undergoing acute and procedural pain. To address this gap, we developed and assessed the clinical utility and preliminary validity of the Youth Acute Pain Functional Ability Questionnaire (YAPFAQ). We evaluated psychometric properties of this measure in 159 patients with sickle cell disease, ages 7 to 21 years, who were hospitalized for vaso-occlusive episodes at 4 urban children's hospitals. The YAPFAQ demonstrated strong internal reliability and test-retest reliability. An exploratory factor analysis was conducted to examine the preliminary factor structure and to help reduce the number of items for the final scale. Evidence for moderate construct validity was demonstrated among validated measures of pain burden, motor function, functional ability, and quality of life. The YAPFAQ is a new measure of youth functional ability in the acute pain setting. Further evaluation of this measure in additional pediatric populations is needed to understand applicability across a spectrum of youth experiencing acute pain related to illness, trauma, and medical/surgical procedures., Perspective: Measures of function in response to acute pain are needed in order to more comprehensively evaluate acute pain interventions in pediatrics; however, no specific measures are available. Our preliminary psychometric evaluation of an acute pain functional ability measure for youth indicates that it may be a promising tool for further refinement in additional pediatric acute pain populations., (Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.)

Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume.

Aim: To determine the prevalence of peptic ulcer and gastric adenocarcinoma in a population of middle and high socio-economic status in Lima, Peru, between 1985 and 2002., Material and Methods: The prevalence of gastroduodenal ulcer and gastric adenocarcinoma was determined after studying by esophagogastroduodenoscopy 31,446 patients at the Policlínico Peruano Japonds (PPJ) between 1985 and 2002. All patients had chronic upper gastrointestinal symptoms and had endoscopically proven diagnosis of active peptic ulcer or histological diagnosis of gastric adenocarcinoma., Results: Analysis of PPJ population identified a decrease in the prevalence of gastric ulcer and duodenal ulcer from 3.15% and 5.05% respectively in 1985, to 1.62% and 2.00% respectively in 2002. Gastric adenocarcinoma prevalence also decreased from 3.19% in 1988 to 0.92% in 2002. The prevalences of gastric ulcer (OR = 1.49, 95% IC 1.26-1.77, p < 0.001), duodenal ulcer (OR = 1.32, 95% IC 1.15-1.51, p < 0.001) and gastric adenocarcinoma (OR = 1.53, 95% IC 1.25-1.86, p < 0.001), decreased in the last eight years., Conclusions: Over the study period, there was a significant decrease in the prevalence of peptic ulcer and gastric adenocarcinoma at the Policlinico Peruano Japonés, where patients from middle and high socio economic status are attended.

Objective: To compare the prevalence of Helicobacter pylori infection in native Peruvians and Japaneses residing in Peru., Methods: Prospective study carried out at "Policlinico Peruano-Japonés" (Lima-Perú). We included Peruvians and Japaneses residing in Peru with chronic symptoms of the upper gastrointestinal tract. Both groups were from medium to high socioeconomic status. We excluded patients with peptic ulcer. PCR, rapid ureasa test and IgG ELISA were used to diagnose the infection., Results: We evaluated 168 Japaneses (mean age 54.6 +/- 12.62 years, 75% female), and 161 Peruvians (mean age of 42.12 +/- 14.48 years, 61.5% female). Using the rapid ureasa test, the prevalence of Helicobacter pylori infection in Peruvians was 47.8%, and in Japaneses 47.0% (p=0.88). Using PCR, in Peruvians was 49.7% and in Japaneses 43.5% (p=0.28)., Conclusion: Peruvians and Japaneses residing in Peru have a similar prevalence of Helicobacter pylori infection, after controlling factors such as socioeconomic status and age, suggesting that in Peru and in these ethnic groups, there is no racial predisposition to acquire the infection.