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OBJECTIVE: Physician-assisted death (PAD) for people with nonterminal illnesses (PAD-NT) is a controversial practice legal in some countries and increasingly debated in others, including the US. A major concern about legalization of PAD-NT is that a lack of resources may drive some with mental illnesses or physical disabilities to seek PAD. METHODS: The authors surveyed 2139 US adults matched to the US population in sex, age, race/ethnicity, education, political affiliation, and income. After giving their opinions regarding terminal PAD and PAD-NT in response to traditional PAD survey questions, respondents were randomly presented one of four scenarios of persons with nonterminal conditions requesting PAD-NT who lacked adequate resources to maintain their quality of life. The type of resources lacking (social or healthcare) and medical condition (mental or physical disability) were varied. Respondents’ views regarding PAD-NT for the scenario specifically and legalization generally were then reassessed. RESULTS: At baseline, 55.4% of respondents supported legalizing terminal PAD and 36.9% supported legalizing PAD-NT. After scenarios, 28.2% (range 18.6% to 39.7%) agreed/strongly agreed with legalizing PAD-NT generally and 23.7% (15.2% to 33.7%) agreed/strongly agreed with PAD-NT for the instance depicted, with mental illness scenarios receiving much lower support; respondents’ comments suggest devaluation of life with physical disability versus with mental illness. Being politically liberal, not religious, and assigned physical disability scenarios were associated with greater support for PAD-NT in multivariable analyses. CONCLUSIONS: A minority of the US public supports PAD-NT in the context of inadequate resources, with much lower support for PAD-NT for mental illness than for physical disability, suggesting that PAD-NT policy debates and future research should address the issue of whether sufficient resources must be available to potential requestors of PAD-NT.

The structure of the 11 / 2 1 + state in 131Sb was investigated at the LOHENGRIN spectrometer of Institut Laue-Langevin via neutron-induced fission of 235U and lifetime measurements, yielding T 1 / 2 = 3 ( 2 ) , at the edge of the sensitivity of the experimental method. This first result for the 11 / 2 1 + state half-life in neutron-rich Sb isotopes provides a quadrupole reduced transition probability to the ground state of B ( E 2 ) = 1.4 − 0.6 + 1.5 W.u., very close to the B ( E 2 ; 2 1 + → 0 1 + ) in 130Sn. Realistic shell-model calculations reproduce well both the experimental level scheme of 131Sb and the B ( E 2 ; 11 / 2 1 + → 7 / 2 1 + ) value, indicting a dominant 2 + ( 130 Sn ) ⊗ π g 7 / 2 core-proton coupled configuration for the 11 / 2 1 + state.

International audience; The multi-nucleon transfer reaction between 136Xe beam and 198Pt target at the beam energy 7 MeV/u was studied using the large acceptance spectrometer VAMOS++ coupled with the newly installed second arm time-of-flight and delayed γ-ray spectrometer CATLIFE (Complementary Arm for Target LIke FragmEnts). The CATLIFE detector is composed of a large area multi-wire proportional chamber and the EXOGAM HPGe clover detectors with an ion flight length of 1230 mm. Direct measurement of the target-like fragments (TLF) and the delayed γ-rays from the isomeric state helps to improve TLF identification. The use of the velocity of TLFs and the delayed γ-ray demonstrate the proof of principle and effectiveness of the new setup.

Background For more than a decade, water-soluble, eco-friendly, biocompatible, and low-toxicity fluorescent nanomaterials have received considerable attention for their numerous in vivo and in vitro applications in biomedical imaging, disease diagnostics, and environmental monitoring. Owing to their tunable photoluminescence properties, carbon-based luminescent nanomaterials have shown great potential in bioimaging, photocatalysis, and biosensing among other applications. Results Marine environments provide excellent resources for the fabrication of these nanomaterials, because many marine organisms contain interesting trigger organic compounds that can be used as precursors. Herein, we synthesize multi-color emissive carbon dots (CDs) with an intrinsic photoluminescence quantum yield of 20.46%. These nanostructures were achieved through the one-step hydrothermal treatment of marine polysaccharide chondroitin sulfate, obtained from shark cartilage, in aqueous solution. Conclusions We successfully demonstrate the low toxicity of our marine resource-derived CDs in zebrafish, and provide an initial assessment of their possible use as a bioimaging agent. Notably, the newly synthesized CDs localize in the intestines of zebrafish larvae, thereby indicating their biocompatibility and potential use as in vivo dyes. How to cite: Kim KW, Choi TY, Kwon YM, et al. Simple synthesis of photoluminescent carbon dots from a marine polysaccharide found in shark cartilage. Electron J Biotechnol 2020;47. https://doi.org/10.1016/j.ejbt.2020.07.003 .

Author(s): Sloan, Emily A; Hilz, Stephanie; Gupta, Rohit; Cadwell, Cathryn; Ramani, Biswarathan; Hofmann, Jeffrey; Kline, Cassie N; Banerjee, Anu; Reddy, Alyssa; Oberheim Bush, Nancy Ann; Chang, Susan; Braunstein, Steve; Chang, Edward F; Raffel, Corey; Gupta, Nalin; Sun, Peter P; Kim, John YH; Moes, Gregory; Alva, Elizabeth; Li, Rong; Bruggers, Carol S; Alashari, Mouied; Wetmore, Cynthia; Garg, Shipra; Dishop, Megan; Van Ziffle, Jessica; Onodera, Courtney; Devine, Patrick; Grenert, James P; Lee, Julieann C; Phillips, Joanna J; Pekmezci, Melike; Tihan, Tarik; Bollen, Andrew W; Berger, Mitchel S; Costello, Joseph F; Perry, Arie; Solomon, David A

Mature progression-free survival (PFS) data from the phase III J-ALEX study showed superiority for alectinib versus crizotinib [hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.26-0.52; median PFS 34.1 versus 10.2 months, respectively] in advanced ALK (anaplastic lymphoma kinase)-positive non-small-cell lung cancer (NSCLC). Overall survival (OS) data were immature (HR 0.80, 99.8799% CI 0.35-1.82) at the time of data cut-off (30 June 2018). We report final OS data after ≥5 years of follow-up.ALK inhibitor naive Japanese patients who were chemotherapy naive or had received one prior chemotherapy regimen were enrolled. Patients were randomized to receive alectinib 300 mg (n = 103) or crizotinib 250 mg (n = 104) twice daily until progressive disease, unacceptable toxicity, death, or withdrawal. The primary endpoint was independent review facility-assessed PFS, with OS (not fully powered) as a secondary endpoint.Median duration of OS follow-up was 68.6 months with alectinib and 68.0 months with crizotinib. Treatment with alectinib did not prolong OS relative to crizotinib (HR 1.03, 95.0405% CI 0.67-1.58; P = 0.9105). Five-year OS rates were 60.9% (95% CI 51.4-70.3) with alectinib and 64.1% (95% CI 54.9-73.4) with crizotinib. In total, 91.3% (n = 95/104) of crizotinib-treated patients and 46.6% (n = 48/103) of alectinib-treated patients received at least one subsequent anticancer therapy. After study drug discontinuation, 78.8% of patients in the crizotinib arm switched to alectinib, while 10.7% of patients in the alectinib arm switched to crizotinib as a first subsequent anticancer therapy. Patients randomized to crizotinib tended to switch treatment earlier than those randomized to alectinib.Final OS analysis from J-ALEX did not show superiority of alectinib to crizotinib; this result was most likely confounded by treatment crossover. Alectinib remains a standard of care for the treatment of patients with advanced ALK-positive NSCLC.

The study of nuclear fission yields has a major impact on the characterization and understanding of the fission process and is mandatory for reactor applications. In the framework of a collaboration between the CEA, the LPSC and the ILL, a program of actinide fission yield measurements has been ongoing for several years at the LOHENGRIN spectrometer. However, the measurement of very low fission yields in the symmetry region and the heavy wing of the distributions is difficult to achieve due to the strong contamination by other masses with much higher yields and requires the development of a new experimental setup. This paper will first present the results of a new absolute measurement of the 235U(nth,f) mass yields using an ionization chamber placed at the exit of the spectrometer. Although very well documented in the literature, these yields show uncertainties lying from 3% to 10% with large discrepancies between libraries and a lack of correlation matrices. New experimental data obtained at the LOHENGRIN spectrometer will be detailed, along with the measurement method and the production of the experimental covariance matrix. The second part will show the development of a Time of Flight (ToF) line in order to improve the background rejection in the mass yield measurements. In the symmetry region, the precision of the measurement is limited by the background estimation due to the charge exchanges with the residual gas of the separator. We plan to analyze the events using a triple coincidence (∆E x E) x ToF, whereas today only (∆E x E) selection is available. The new ToF line is built using Si3N4 foils and secondary electron detectors (SED) for the start and stop detectors. We will present the choices made for the SED technology along with the progress achieved on the ToF line characterization.

Objectives The International Council of Nurses supports the development of International Classification for Nursing Practice® (ICNP®) catalogues to support the construction of electronic health records and evidence-based practice. Such a catalogue is needed for inpatient falls. Methods The ICNP®-Based Inpatient Fall-Prevention Catalogue ('The Catalogue') was developed following the six steps recommended by the International Council of Nurses: (1) identifying inpatient falls as a priority, (2) gathering relevant concepts from 10 international guidelines and comparing locally defined sets of fall-prevention terms, (3) mapping the concepts to the ICNP® terminology, (4) identifying new concepts, (5) conducting a clinical face validation with a 12-member panel and finalizing The Catalogue and (6) setting a strategy for dissemination. The high-level structure of the International Classification for Patient Safety was used as a theoretical framework. Results Eighteen nursing care elements and 141 terms were identified. A local vocabulary set had 89 terms (63.1%) that all corresponded to the identified terms. The exact and post-coordination mapping rates to the ICNP® were 75% and 40.6% for assessment/diagnosis/outcomes and interventions, respectively. The 54 new terms corresponded to 52 primitive concepts. An external review of The Catalogue showed that it had adequate understandability and validity. However, one-third of assessments/diagnoses/outcomes and one-fourth of interventions were not found in a tertiary hospital practice. Conclusion A fall-prevention catalogue has been developed based on evidence and a theoretical framework and also clinically validated. Implication for nursing and health policy The Catalogue is a standardized interface terminology and content subset in any electronic health records system that can directly deliver evidence on fall prevention. It can also be used as an informatics tool to aggregate, analyse, interpret and compare nursing data worldwide.

Author(s): Sloan, Emily A; Cooney, Tabitha; Oberheim Bush, Nancy Ann; Buerki, Robin; Taylor, Jennie; Clarke, Jennifer L; Torkildson, Joseph; Kline, Cassie; Reddy, Alyssa; Mueller, Sabine; Banerjee, Anu; Butowski, Nicholas; Chang, Susan; Mummaneni, Praveen V; Chou, Dean; Tan, Lee; Theodosopoulos, Philip; McDermott, Michael; Berger, Mitchel; Raffel, Corey; Gupta, Nalin; Sun, Peter P; Li, Yi; Shah, Vinil; Cha, Soonmee; Braunstein, Steve; Raleigh, David R; Samuel, David; Scharnhorst, David; Fata, Cynthia; Guo, Hua; Moes, Gregory; Kim, John YH; Koschmann, Carl; Van Ziffle, Jessica; Onodera, Courtney; Devine, Patrick; Grenert, James P; Lee, Julieann C; Pekmezci, Melike; Phillips, Joanna J; Tihan, Tarik; Bollen, Andrew W; Perry, Arie; Solomon, David A

Since complex structure of the human respiratory system leads to the profound effect of the air flow and particle deposition, a realistic and flexible airway model is crucial for predicting in vivo lung deposition of pharmaceutical aerosol. This work presented a CFD study of air and particle flows in a realistic parametrically controlled airway model developed by Kitaoka under different inspiratory conditions. The results were analysed with simulation data obtained in the classic Weibel airway (WA) model and compared with previous experimental and simulation studies. The comparison showed both difference and similarity between two models. The inspiratory airflow was symmetric in the WA model, whereas in the Kitaoka model non-symmetrical airflow was dominated throughout airways. The Kitaoka model, in comparison to the WA model, also showed more complicated particle deposition pattern with larger particle deposition efficiency. The flow rate, however, showed a similar effect to both models; i.e. generally particle deposition efficiency was higher as flowrate was higher. The Kitaoka model was then extended from 7 generations (KG7) to 11 generations (KG11) to study the effect of airway generation. The simulations showed little difference between two structures in terms of inspiratory air velocity and particle deposition efficiency. This suggests that the KG7 model is sufficiently structured to obtain realistic particle deposition pattern. The study demonstrates the Kitaoka model has a great potential in modelling lung deposition of particles under different conditions.

Background This 24-week, multicenter, randomized, exploratory, comparative, open-label, phase-IV study assessed the safety and efficacy of prolonged-release tacrolimus (PR-T) with reduced-dose versus standard-dose corticosteroids in stable kidney transplant recipients in Korea after converting from cyclosporine-based therapy. Methods At baseline, patients were converted from cyclosporine-based to PR-T-based immunosuppression and randomized (1:1) to receive either corticosteroids maintained at prestudy dose (standard-dose group) or tapered from week 4 to 50% of the prestudy dose by week 12 (reduced-dose group). Patients were seen at baseline and weeks 1, 4, 12, and 24. The primary endpoint was change in estimated glomerular filtration rate (Modification-of-Diet-in-Renal-Disease-4) between baseline and week 24. Secondary endpoints included either acute rejection or patient-reported satisfaction with PR-T. Adverse events (AEs) were recorded. Results Overall, 150 patients were randomized into a reduced-dose group (n = 73) and a standard-dose group (n = 77). At week 24, mean ± standard deviation for corticosteroid dose was 2.5 ± 0.9 mg and 5.0 ± 1.3 mg, respectively. Mean change in estimated glomerular filtration rate from baseline to week 24 was +1.5 ± 9.1 mL/min/1.73 m2 (P = .1567) and +3.4 ± 10.6 mL/min/1.73 m2 (P = .0065), respectively, and not significantly different between groups. There were no acute rejection episodes. Most respondents (>70%) considered PR-T more convenient than cyclosporine. AE incidence was similar between groups. The most common AEs experienced by ≥3% of patients in either treatment group were gastrointestinal events (20.8% and 28.6% of patients receiving reduced- and standard-dose corticosteroids, respectively). Most AEs in both treatment groups were mild or moderate in severity. Conclusion Renal function was maintained following conversion from cyclosporine to PR-T, irrespective of corticosteroid regimen; PR-T enables reduced corticosteroid dosage.