Search

An international panel of experts in the field of urinary cytopathology conducted a survey, supported by the American Society of Cytopathology, to seek opinions, gather evidence, and identify practice patterns regarding urinary cytology before and after the introduction of The Paris System for Reporting Urinary Cytopathology (TPS). Results from this survey were utilized in the development of the second edition of TPS (TPS-2.0).The study group, originally formed during the 2013 International Congress of Cytology, reconvened at the 2019 annual meeting of the American Society of Cytopathology. To prepare for the second edition of TPS, the group generated a survey that included 43 questions related to the taxonomy and practice of urinary cytology.A total of 523 participant responses were collected, and 451 from 54 countries passed a qualifying screen. Three hundred ninety-four participants provided information about their work settings. Eighty-two percent (218/266) of responding participants use TPS. One hundred sixty-eight people who responded on their urinary cytology atypia rates reported an average decrease from 21.6% to 16%. Over three fourths of participants felt that the same criteria should be used for upper and lower tract interpretations and for instrumented and voided samples. There were varied opinions on addressing atypical squamous cells and suggestions for an expanded discussion of the issue to be included in TPS 2.0.Results of the survey demonstrate strong support for TPS and show a decreased self-reported atypia rate in the laboratories using TPS. The majority of participants related that the criteria put forth for the reporting categories were user-friendly and applied with relative ease. The comment section of the survey included suggestions from the participants for further improvement of TPS. Results of this survey have been useful in fine-tuning and advancing TPS. They were considered along with recent literature to generate the second edition of TPS.

Hyperbaric oxygen (HBO

To investigate inpatient satisfaction with surgical resident care.Surgical trainees are often the primary care providers to surgical inpatients, yet patient satisfaction with surgical resident care is not well characterized or routinely assessed.English-speaking, general surgery inpatients recovering from elective gastrointestinal and oncologic surgery were invited to complete a survey addressing their satisfaction with surgical resident care. Patients positively identified photos of surgical senior residents and interns before completing a modified version of the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS). Adapted S-CAHPS items were scored using the "top-box" method.Ninety percent of recruited patients agreed to participate (324/359, mean age=62.2, 50.3% male). Patients were able to correctly identify their seniors and interns 85% and 83% of the time, respectively (P=0.14). On a ten-point scale, seniors had a mean rating of 9.23+/-1.27 and interns had a mean rating of 9.01+/-1.49 (P=0.14). Ninety-nine percent of patients agreed it was important to help in the education of future surgeons.Surgical inpatients were able to recognize their resident physicians with high frequency and rated resident care highly overall, suggesting that they may serve as a willing source of feedback regarding residents' development of core competencies such as interpersonal skills, communication, professionalism, and patient care. Future work should investigate how to best incorporate patient evaluation of surgical resident care routinely into trainee assessment to support resident development.

Robotic thoracic surgery has demonstrated benefits. We aimed to evaluate implementation of a robotic thoracic surgery program on postoperative outcomes at our Veteran's Administration Medical Center (VAMC). We retrospectively reviewed our VAMC database from 2015 to 2021. Patients who underwent surgery with intention to treat lung nodules were included. Primary outcome was patient length of stay (LOS). Patients were grouped by surgical approach and stratified to before and after adoption of robotic surgery. Univariate comparison of postoperative outcomes was performed using Wilcoxon rank sums and chi-squared tests. Multivariate regression was performed to control for ASA class. P values 0.05 were considered significant. Outcomes of 108 patients were assessed. 63 operations (58%) occurred before and 45 (42%) after robotic surgery implementation. There were no differences in patient preoperative characteristics. More patients underwent minimally invasive surgery (MIS) in the post-implementation era than pre-implementation (85% vs. 42%, p 0.001). Robotic operations comprised 53% of operations post-implementation. On univariate analysis, patients in the post-implementation era had a shorter LOS vs. pre-implementation, regardless of surgical approach (mean 4.7 vs. 6.0 days, p = 0.04). On multivariate analysis, patients who underwent MIS had a shorter LOS [median 4 days (IQR 2-6 days) vs. 7 days (6-9 days), p 0.001] and were more likely to be discharged home than to inpatient facilities [OR (95% CI) 13.00 (1.61-104.70), p = 0.02]. Robotic thoracic surgery program implementation at a VAMC decreased patient LOS and increased the likelihood of discharging home. Implementation at other VAMCs may be associated with improvement in some patient outcomes.

Objectives: Emergency departments (EDs) could play an important role in the COVID-19 pandemic response by reaching patients who would otherwise not seek vaccination in the community. Prior to expanding COVID-19 vaccination to the acute care setting, we assessed ED patients’ COVID-19 vaccine status, perspectives, and hypothetical receptivity to ED-based vaccination. Methods: From January 11 through March 31, 2021, we conducted a multisite (Albany Medical Center, Boston Medical Center, Buffalo General Hospital, University of Cincinnati Medical Center, and Upstate Medical Center), cross-sectional survey of ED patients, with embedded randomization for participants to receive 1 of 4 vignette vaccination messages (simple opt-in message, recommendation by the hospital, community-oriented message, and acknowledgment of vaccine hesitancy). Main outcomes included COVID-19 vaccination status, prior intention to be vaccinated, and receptivity to randomized hypothetical vignette messages. Results: Of 610 participants, 122 (20.0%) were vaccinated, 234 (38.4%) had prior intent to be vaccinated, 111 (18.2%) were unsure as to prior intent, and 143 (23.4%) had no prior intent to be vaccinated. Vaccine hesitancy (participants who were vaccine unsure or did not intend to receive the vaccine) was associated with the following: age Conclusions: EDs have appropriate patient populations to initiate COVID-19 vaccination programs as a supplement to community efforts. A simple opt-in approach may offer the best messaging to reach vaccine-hesitant ED patients.

Following the amazing acceptance of The Paris System for Reporting Urinary Cytology (TPS), the second edition (TPS 2.0) was inevitable. Based on new studies since the publication of the first edition, diagnostic criteria are refined, and pitfalls discussed. In addition to reinforcing the mandate that the focus of diagnostic urinary cytology is the detection of high-grade urothelial carcinoma, other issues are addressed. Low-grade lesions are included in the category of negative for high-grade urothelial cancer. The rationale for that decision is strongly supported by evidence from the authors' experiences as well as the recent literature. A new chapter on urine cytology of the upper tract, a rarely addressed topic, explores the challenges involved. Furthermore, the issue of cellular degeneration is discussed in the criteria of all diagnostic categories. Most importantly, data defining the risk of high-grade malignancy (ROHM) for each diagnostic category informs clinical management. The 65 authors are recognized authorities from 33 countries, attesting to the global impact of TPS 2.0.

Brain fog is a kind of mental problem, similar to chronic fatigue syndrome, and appears about 3 months after the infection with COVID-19 and lasts up to 9 months. The maximum magnitude of the third wave of COVID-19 in Poland was in April 2021. The research referred here aimed at carrying out the investigation comprising the electrophysiological analysis of the patients who suffered from COVID-19 and had symptoms of brain fog (sub-cohort A), suffered from COVID-19 and did not have symptoms of brain fog (sub-cohort B), and the control group that had no COVID-19 and no symptoms (sub-cohort C). The aim of this article was to examine whether there are differences in the brain cortical activity of these three sub-cohorts and, if possible differentiate and classify them using the machine-learning tools. he dense array electroencephalographic amplifier with 256 electrodes was used for recordings. The event-related potentials were chosen as we expected to find the differences in the patients' responses to three different mental tasks arranged in the experiments commonly known in experimental psychology: face recognition, digit span, and task switching. These potentials were plotted for all three patients' sub-cohorts and all three experiments. The cross-correlation method was used to find differences, and, in fact, such differences manifested themselves in the shape of event-related potentials on the cognitive electrodes. The discussion of such differences will be presented; however, an explanation of such differences would require the recruitment of a much larger cohort. In the classification problem, the avalanche analysis for feature extractions from the resting state signal and linear discriminant analysis for classification were used. The differences between sub-cohorts in such signals were expected to be found. Machine-learning tools were used, as finding the differences with eyes seemed impossible. Indeed, the A&B vs. C, B&C vs. A, A vs. B, A vs. C, and B vs. C classification tasks were performed, and the efficiency of around 60–70% was achieved. In future, probably there will be pandemics again due to the imbalance in the natural environment, resulting in the decreasing number of species, temperature increase, and climate change-generated migrations. The research can help to predict brain fog after the COVID-19 recovery and prepare the patients for better convalescence. Shortening the time of brain fog recovery will be beneficial not only for the patients but also for social conditions.

Recombinant human erythropoietin (rhEPO) has potent procognitive effects, hematopoiesis-independent, but underlying mechanisms and physiological role of brain-expressed EPO have remained obscure. Here, we provide encyclopedic transcriptional hippocampal profiling of mice treated with rhEPO. Based on ∼108,000 single nuclei, we unmask multiple pyramidal lineages with their comprehensive molecular signatures. By temporal profiling and gene regulatory analysis, we build a developmental trajectory of CA1 pyramidal neurons derived from multiple predecessor lineages and elucidate gene regulatory networks underlying their fate determination. With EPO as ꞌtoolꞌ, we discover novel populations of newly differentiating pyramidal neurons, overpopulating to ∼200% upon rhEPO with upregulation of genes crucial for neurodifferentiation, dendrite growth, synaptogenesis, memory formation, and cognition. Using a Cre-based approach to visually distinguish pre-existing from newly formed pyramidal neurons for patch-clamp recordings, we learn that rhEPO treatment differentially affects excitatory and inhibitory inputs. Our findings provide mechanistic insight into how EPO modulates neuronal functions and networks.

Objective: Rare inherited missense variants in SLC32A1, the gene that encodes the vesicular gamma-aminobutyric acid (GABA) transporter, have recently been shown to cause genetic epilepsy with febrile seizures plus. We aimed to clarify if de novo missense variants in SLC32A1 can also cause epilepsy with impaired neurodevelopment.Methods: Using exome sequencing, we identified four individuals with a developmental and epileptic encephalopathy and de novo missense variants in SLC32A1. To assess causality, we performed functional evaluation of the identified variants in a murine neuronal cell culture model.Results: The main phenotype comprises moderate-to-severe intellectual disability, infantile-onset epilepsy within the first 18 months of life, and a choreiform, dystonic, or dyskinetic movement disorder. In silico modeling and functional analyses reveal that three of these variants, which are located in helices that line the putative GABA transport pathway, result in reduced quantal size, consistent with impaired filling of synaptic vesicles with GABA. The fourth variant, located in the vesicular gamma-aminobutyric acid N-terminus, does not affect quantal size, but increases presynaptic release probability, leading to more severe synaptic depression during high-frequency stimulation. Thus, variants in vesicular gamma-aminobutyric acid can impair GABAergic neurotransmission through at least two mechanisms, by affecting synaptic vesicle filling and by altering synaptic short-term plasticity.Interpretation: This work establishes de novo missense variants in SLC32A1 as a novel cause of a developmental and epileptic encephalopathy. SUMMARY FOR SOCIAL MEDIA IF PUBLISHED: @platzer_k @lemke_johannes @RamiJamra @Nirgalito @GeneDx The SLC family 32 Member 1 (SLC32A1) is the only protein identified to date, that loads gamma-aminobutyric acid (GABA) and glycine into synaptic vesicles, and is therefore also known as the vesicular GABA transporter (VGAT) or vesicular inhibitory amino acid transporter (VIAAT). Rare inherited missense variants in SLC32A1, the gene that encodes VGAT/vesicular inhibitory amino acid transporter, have recently been shown to cause genetic epilepsy with febrile seizures plus. We aimed to clarify if de novo missense variants in SLC32A1 can also cause epilepsy with impaired neurodevelopment. We report on four individuals with de novo missense variants in SLC32A1 and a developmental and epileptic encephalopathy with infantile onset epilepsy. We establish causality of the variants via in silico modeling and their functional evaluation in a murine neuronal cell culture model. SLC32A1 variants represent a novel genetic etiology in neurodevelopmental disorders with epilepsy and a new GABA-related disease mechanism.

IntroductionWilms Tumor (WT), or nephroblastoma, is the most common pediatric kidney cancer. Most WTs display a “favorable” triphasic histology, in which the tumor is comprised of blastemal, stromal, and epithelial cell types. Blastemal predominance after neoadjuvant chemotherapy or diffuse anaplasia (“unfavorable” histology; 5-8%) portend a worse prognosis. Blastema likely provide the putative cancer stem cells (CSCs), which retain molecular and histologic features characteristic of nephron progenitor cells (NPCs), within WTs. NPCs arise in the metanephric mesenchyme (MM) and populate the cap mesenchyme (CM) in the developing kidney. WT blastemal cells, like NPCs, similarly express markers, SIX2 and CITED1. Tumor xenotransplantation is currently the only dependable method to propagate tumor tissue for research or therapeutic screening, since efforts to culture tumors in vitro as monolayers have invariably failed. Therefore, a critical need exists to propagate WT stem cells rapidly and efficiently for high-throughput, real-time drug screening.MethodsPreviously, our lab developed niche conditions that support the propagation of murine NPCs in culture. Applying similar conditions to WTs, we assessed our ability to maintain key NPC "stemness" markers, SIX2, NCAM, and YAP1, and CSC marker ALDHI in cells from five distinct untreated patient tumors.ResultsAccordingly, our culture conditions maintained the expression of these markers in cultured WT cells through multiple passages of rapidly dividing cells.DiscussionThese findings suggest that our culture conditions sustain the WT blastemal population, as previously shown for normal NPCs. As a result, we have developed new WT cell lines and a multi-passage in vitro model for studying the blastemal lineage/CSCs in WTs. Furthermore, this system supports growth of heterogeneous WT cells, upon which potential drug therapies could be tested for efficacy and resistance.

Background The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transesophageal echocardiography (TEE) in patients with atrial fibrillation and atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes. Methods The research is a substudy of multicenter, prospective, observational Left Atrial Thrombus on Transesopahgeal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TEE prior to direct current cardioversion or catheter ablation. TEE parameters, including presence of LAT, were compared between patients with and without HF, as well as different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF) and reduced ejection fraction (HFrEF). Results HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%, P Conclusion The diagnosis of HFrEF, but not HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation in the assessed population. TEE should be considered in these patients prior to cardioversion or catheter ablation despite adequate oral anticoagulation. Funding Acknowledgement Type of funding sources: None.

Background Atrial fibrillation and flutter (AF/AFl) increase the risk of thromboembolic events by promoting clot formation in the left atrium (LA), which can be visualised using transoesophageal echocardiography (TEE). Current guidelines recommend initiation of oral anticoagulation (OAC) in patients with AF/AFl based solely on CHA2DS2VASc score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, history of stroke or thromboembolism, vascular disease, age 65 to 74 years, female sex). Yet, some patients develop left LA thrombus (LAT) and experience thromboembolic events despite OAC. Purpose We sought to develop and externally validate a machine learning model for prediction of presence of LAT based on clinical, laboratory and transthoracic echocardiography (TTE) features. Methods We analyzed data from the multicenter, prospective LATTEE registry (Left Atrial Thrombus on Transesophageal Echocardiography) that included patients from 13 sites who underwent TEE before cardioversion or ablation between November 2018 and March 2021. We used XgBoost model to predict presence of LAT in TEE based on 29 clinical features, 10 biomarkers and 5 TTE measurements. We trained and tested the model internally using 10-fold hold-out cross validation and data from 12 sites (N=2489). We then tested the final model externally using data from the 13th site (that had recruited most patients, N=400). We compared the predictive performance with that of CHA2DS2VASc score using areas under receiver operating curve (AUC) and DeLong test. Results In the training and internal testing cohort the median age was 67 (Inter Quartile Range [IQR] 59, 74), 63% were male, 85% received OAC and LAT was found in 8.4%. Ablation was the indication for TEE in 43%, cardioversion in 57%. In internal, 10-fold hold-out cross validation, the model achieved AUC of 0.755 (95% confidence interval [CI]: 0.722, 0.788) while CHA2DS2VASc performed significantly worse with AUC of 0.638 (95% CI: 0.604, 0.673), P In the external testing cohort the median age was 67 (IQR 59, 74), 66% were male, 88% received OAC, ablation was the indication for TEE in 49% of cases and LAT was found in 6.8%. In this external cohort, our model achieved AUC of 0.815 (95% CI: 0.741, 0.889) while CHA2DS2VASc performed significantly worse with AUC of 0.684 (95% CI: 0.583, 0.785), P=0.028. Conclusion Machine learning based on readily available clinical data allows accurate prediction of the presence of LAT in patients with AF/AFl irrespective of OAC treatment. Such score could be used to identify patients who should undergo TEE before ablation or cardioversion. Subsequent studies to clinically evaluate such application of our model as well as how the model can predict future thromboembolic events are warranted. Funding Acknowledgement Type of funding sources: None.

BACKGROUNDWhile inhaled corticosteroids (ICS) are considered the essential foundation of most asthma therapy, ICS inhaler nonadherence is a notoriously common problem and a significant cause of asthma-related morbidity. Partially acknowledging the problem of nonadherence, international organizations recently made paradigm-shifting recommendations that all patients with mild-to-moderate persistent asthma be considered for symptom-driven ICScontaining inhalers rather than relying on adherence to traditional maintenance ICS inhalers and symptom-driven short-acting beta-agonists (SABA). With this new approach, asthma patients are at least exposed to the important anti-inflammatory effects of ICS-containing inhalers when their symptom reliever inhaler is deployed due to acute symptoms. METHODSThis study will ( Part 1 ) complete a pragmatic randomized-controlled trial to evaluate if an inhaler strategy that utilizes symptom-driven ICS inhalers is particularly beneficial in maintenance ICS inhaler non-adherent asthma patients, and ( Part 2 ) use a dissemination and implementation (D&I) science conceptual framework to better understand patients’ and providers’ views of inhaler nonadherence. This study, which will have an option of taking place entirely remotely, will use a Food and Drug Administration (FDA)-approved electronic sensor (Hailie® sensor) to monitor inhaler adherence and includes semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). DISCUSSIONThis study is assessing the problem of nonadherence using a D&I implementation science research lens while testing a new inhaler approach to potentially ameliorate the detrimental consequences of maintenance inhaler nonadherence. We hypothesize that the use of a symptom-driven ICS/LABA management strategy, as compared to traditional maintenance ICS treatment and symptom-driven SABA, will lead to improved adherence to an asthma treatment strategy, decreased asthma-related morbidity, less cumulative ICS exposure, and greater patient satisfaction with an inhaler approach. TRIAL REGISTRATIONThe study was registered via ClinicalTrials.gov on November 8, 2021. The registration number is NCT05111262.

Background While inhaled corticosteroids (ICS) are considered the essential foundation of most asthma therapy, ICS inhaler nonadherence is a notoriously common problem and a significant cause of asthma-related morbidity. Partially acknowledging the problem of nonadherence, international organizations recently made paradigm-shifting recommendations that all patients with mild-to-moderate persistent asthma be considered for symptom-driven ICS-containing inhalers rather than relying on adherence to traditional maintenance ICS inhalers and symptom-driven short-acting beta-agonists (SABA). With this new approach, asthma patients are at least exposed to the important anti-inflammatory effects of ICS-containing inhalers when their symptom reliever inhaler is deployed due to acute symptoms. Methods This study will (Part 1) complete a pragmatic randomized controlled trial to evaluate if an inhaler strategy that utilizes symptom-driven ICS inhalers is particularly beneficial in maintenance ICS inhaler non-adherent asthma patients, and (Part 2) use a dissemination and implementation (D&I) science conceptual framework to better understand patients’ and providers’ views of inhaler nonadherence. This study, which will have an option of taking place entirely remotely, will use a Food and Drug Administration (FDA)-approved electronic sensor (Hailie® sensor) to monitor inhaler adherence and includes semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Discussion This study is assessing the problem of nonadherence using a D&I implementation science research lens while testing a new inhaler approach to potentially ameliorate the detrimental consequences of maintenance inhaler nonadherence. We hypothesize that the use of a symptom-driven ICS/LABA management strategy, as compared to traditional maintenance ICS treatment and symptom-driven SABA, will lead to improved adherence to an asthma treatment strategy, decreased asthma-related morbidity, less cumulative ICS exposure, and greater patient satisfaction with an inhaler approach. Trial registration ClinicalTrials.gov NCT05111262. Registered on November 8, 2021.

The objective of this study was to evaluate the educational impact following the implementation of a robotic thoracic surgery program on cardiothoracic (CT) surgery trainees. We hypothesized that the introduction of a robotic thoracic surgery program would adversely affect the CT surgery resident experience, decreasing operative involvement and subsequent competency of surgical procedures. CT surgery residents and thoracic surgery attendings from a single academic institution were administered a recurring, electronic survey from September 2019 to September 2020 following each robotic thoracic surgery case. Surveys evaluated resident involvement and operative performance. This study was exempt from review by our Institutional Review Board. Attendings and residents completed surveys for 86 and 75 cases, respectively. Residents performed > 50% of the operation independently at the surgeon console in 66.2 and 73.3% of cases according to attending and resident responses, respectively. The proportion of trainees able to perform > 75% of the operation increased with each increasing year in training (p = 0.002). Based on the Global Evaluative Assessment of Robotic Skills grading tool, third-year residents averaged higher scores compared to first-year residents (22.9 versus 17.4 out of 30 possible points, p

Background The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary aim of this study was to assess the potential increase in screening for HIV and HCV in an academic central Appalachian emergency department (ED) through the use of Best Practice Alerts (BPAs) in the electronic medical record (EMR). A secondary aim was to assess for an increase in linkage to care using patient navigators. Methods EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. Results The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7106 (33.7%) patients were screened for HIV and 3496 (29.2%) patients were screened for HCV, for an overall testing increase of 2269% and 1065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100, and 14% for HCV to 64%. Conclusion HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks.

Mycobacterium abscessus surgical site infections are rare, but notoriously difficult to treat. Eradication requires aggressive surgical resection, removal of foreign material, prolonged antibiotics, and consideration of delayed reconstruction.

Coronavirus disease 2019 (COVID-19) has caused everything from daily hassles, relationship issues, and work pressures to health concerns and debilitating phobias. Relaxation techniques are one example of the many methods used to address stress, and they have been investigated for decades. In this study, we aimed to check whether there are differences in the brain cortical activity of participants during relaxation or mental workload tasks, as observed using dense array electroencephalography, and whether these differences can be modeled and then classified using a machine learning classifier. In this study, guided imagery as a relaxation technique was used in a randomized trial design. Two groups of thirty randomly selected participants underwent a guided imagery session; other randomly selected participants performed a mental task. Participants were recruited among male computer science students. During the guided imagery session, the electroencephalographic activity of each student’s brain was recorded using a dense array amplifier. This activity was compared with that of a group of another 30 computer science students who performed a mental task. Power activity maps were generated for each participant, and examples are presented and discussed to some extent. These types of maps cannot be easily interpreted by therapists due to their complexity and the fact that they vary over time. However, the recorded signal can be classified using general linear models. The classification results as well as a discussion of prospective applications are presented.

In this article we present an all-fiber vector bend sensor by means of a self-fabricated micro-structured multicore optical fiber. The reported solution is based on differential intensity variations of the light transmitted along the cores whose changes are influenced by the bending angle and orientation. The unique asymmetric structure of the air-holes in the optical fiber provides each core with different confinement losses of the fundamental mode depending on the bending radius and orientation, making each of the cores bend-sensitive in a range of at least 80°. It has been experimentally demonstrated that the reported sensor enables the bending angle and orientation to be detected in a full range of 360° without any dead-zones, and the possibility of end point detection with millimeter precision. Additionally, a reconstruction of the bending vector has been carried out theoretically, and a good match can be observed between the experimental and theoretical data.

Purpose Heavy metal soluble forms pose a threat to plants, soil microflora, and microfauna. To limit their toxicity and mobility, various immobilizing additives are being developed. The main aim of the study was to determine the influence of soil flocculant (cationic polyacrylamide (CtPAM)) on the hexavalent chromium ion reduction and accumulation on the kaolinite surface. In this way, the efficiency of the selected polymer conditioner in the soil remediation was determined. Materials and methods The adsorbed amounts of Cr(VI) and CtPAM on the kaolinite surface was determined spectrophotometrically (spectrophotometer UV/Vis) using specific indicators. The structure of electrical double layer formed on the kaolinite surface in the mixed system of cationic polyacrylamide and Cr(VI) ions was described based on the adsorptive measurements, zeta potential measurements, as well as potentiometric titration. The kaolinite aggregation in the presence of CtPAM and/or Cr(VI) ions was determined spectrophotometrically and proved using SEM microscopy. The reduction process of Cr(VI) to Cr(III) occurring in the adsorption layer was determined by diffuse reflectance spectroscopy (DRS). Results and discussion The obtained results indicated that cationic polyacrylamide contributes to Cr(VI) reduction to Cr(III) form in the kaolinite suspension. This heavy metal ions are strongly adsorbed by the applied clay mineral, especially at pH 5 (then the Cr(VI)-adsorbed amount equals 5.42 mg/g). The CtPAM addition favors the Cr(VI) ion immobilization on the kaolinite surface. In the conditioner presence, the heavy metal-adsorbed amount is even at 7.34 mg/g. The adsorption of CtPAM and chromium(VI) ions induces changes in the kaolinite surface charge density and electrokinetic potential. What is more, both substances favors the kaolinite aggregation. Conclusions Cationic polyacrylamide may be considered a substance reducing the toxicity of chromium(VI) ions in the natural environment and decreasing their availability for soil organisms. It can improve the soil structure (by stimulating aggregation) and reduce environment pollution with heavy metals simultaneously.

Background Body fluid cytology (BFC) is an important tool in the diagnosis and staging of malignancy and is aided by the judicious use of immunohistochemistry (IHC). The aim of this study was to determine the usage rates of IHC stains in BFC, their type and indications, and their diagnostic impact. We also attempted to estimate the optimal rate of IHC use in BFC by comparing the entire laboratory's and each individual cytopathologist's IHC use rates with their respective indeterminate and malignant diagnosis rates. Methods We conducted a retrospective study of IHC stain use in BFC during a 5.5-year interval (2013-2018) and determined the laboratory's and each individual cytopathologist's IHC usage patterns according to the final diagnosis, site, and indications for their use. Results A total of 477 out of 4144 (11.5%) BFC cases had 2128 individual immunostains performed, with an average of 4.5 immunostains per case. Individual cytopathologists used IHC stains on 6.7% to 22% of their BFC cases. Pathologists with higher rates of IHC stain use than the laboratory's mean were less experienced and had higher rates of indeterminate but not of malignant diagnoses. The most common indication for the use of IHC stains was differentiating mesothelial from malignant cells. MOC31, calretinin, Ber-EP4, CD68, and D2-40 were the most commonly used of the 67 different IHC stains used in BFC. Conclusions The laboratory's mean may represent the optimal IHC use rate, as higher IHC use rates did not lead to more diagnostic certainty or higher pickup rates of malignant cells.

BACKGROUND The Centers for Disease Control and Prevention recommends screening baby boomers and high-risk patients for hepatitis C virus (HCV); however, the incidence of HCV is rapidly increasing among younger populations, and screening is limited by access to care and risk factor assessment. The purpose of this study was to evaluate characteristics of HCV antibody-positive (Ab+) and ribonucleic acid (RNA)-confirmed-positive patients identified via two screening models in an Appalachian emergency department (ED). METHODS This was a retrospective cohort study of patients who screened HCV Ab+ in the ED from January 1 to October 31, 2018. Data were extracted, and comparative analyses were conducted between the risk-based and the universal screening models. RESULTS Overall, 444 patients screened HCV Ab+, with a median age of 39 years. From January to May 2018, the risk factor model identified 126 HCV Ab+ patients out of 3,014 screened (4%), whereas from June to October 2018, the universal model identified 318 HCV Ab+ patients out of 5,407 screened (6%; p

The representation of the surrounding world emerges through integration of sensory information and actions. We present a novel neural model which implements non-local, parallel information processing on a neocolumnar architecture with lateral interconnections. Information is integrated into a holographic wave interference pattern. We compare the simulated in silico pattern with observed in vivo invasive and non-invasive electrophysiological data in human and non-human primates. Our model replicates the modulation of neural high-frequency activity during visual perception showing that phase-locked low and high-frequency oscillations self-organize efficiently and carry high information content. The simulation further models how criticality (high content) of information processing emerges given a sufficiently high number of correlated neurons. Non-local information processing, forming one holographic wave pattern, suggests a platform for emergence of conscious perception.One sentence summarySimulated non-local information processing on a neocolumnar architecture models well multiple electrophysiological observations of brain activity, including high-frequency activity during visual perception in primates.

Telecytology offers a suitable solution to the cost and time efficiency questions on rapid onsite evaluation (ROSE). An increasing number of institutions are adopting new telecytology systems to meet the increasing ROSE requests, although there is no agreement on the details of how a telecytology validation study needs to be conducted. We propose a standardized approach for telecytology validation studies that could be done in a variety of practices.Consecutive cases from 6 months prior were chosen to reflect a case mix comparable to real life. A fellow assessed the slides at the ROSE site while 6 cytopathology faculty convened in a conference room with a television screen, and noted the adequacy, diagnostic category, and specific diagnoses. All participants were blinded to the original adequacy assessment and final diagnoses. For each case, evaluation time and the slides counts were noted.Fine-needle aspiration specimens from 52 patients were included in the study. Of these, 13 cases were used in the first "test" session. The adequacy concordance rates ranged between 92.3% and 100%, with an overall concordance rate of 94.8%. The diagnostic category concordance rates ranged between 90.3% and 95.5%, with an overall concordance rate of 91.9%. The specific diagnosis concordance rates ranged between 84.6% and 92.9%, with an overall concordance rate of 88.1%.Validation of telecytology requires a standardized approach just like any other new technology. In this study, we propose an efficient and accurate method for cytopathology departments of various case volumes to conduct telecytology validation studies.

STUDY OBJECTIVE Access to naloxone is a priority for reducing opioid deaths. Although community members who complete naloxone training are able to administer nasal naloxone successfully and rapidly, little is known about the ability of community members to administer naloxone without training. The objective of this study was to assess the ability of untrained individuals to administer naloxone successfully in a simulated opioid overdose setting. DESIGN Prospective single-site open-label randomized usability assessment. SETTING Scenario station at a large state fair during August and September 2017. PARTICIPANTS A total of 207 healthy adults who were randomly assigned to administer naloxone using a nasal spray (NS) device (69 participants), an intramuscular (IM) kit (68 participants), or an improvised nasal atomizer (AT) kit (70 participants). INTERVENTION Participants were instructed to administer the device to a high-fidelity mannequin in a public environment with distractions to mimic those that might be present in an actual overdose. No device instructions or administration materials were provided. MEASUREMENTS AND MAIN RESULTS Participants were assessed by trained study team members who directly observed all naloxone administrations using the predetermined end-point criteria. Individual participant perceptions were evaluated immediately following the naloxone administration using a standardized questionnaire form. The primary outcome was successful administration, defined as administration within 7 minutes and without critical errors. Secondary outcomes were time to successful naloxone administration and ease of use of the device. The NS (66.7%, p