bluuebunny/crossref_metadata_2025 huggingface dataset:
Topologically protected moiré exciton at a twist-boundary in a van der Waals heterostructure
Authors: Chaves Andrey , Covaci Lucian , Peeters François M , Milošević Milorad V
Published: February 2022

A twin boundary in one of the layers of a twisted van der Waals heterostructure separates regions with near opposite inter-layer twist angles. In a MoS2/WSe2 bilayer, the regions with

R
h
h

and

R
h
X

stacking registry that defined the sub-lattices of the moiré honeycomb pattern would be mirror-reflected across such a twist boundary. In that case, we demonstrate that topologically protected chiral moiré exciton states are confined at the twist boundary. These are one-dimensional and uni-directional excitons with opposite velocities for excitons composed by electronic states with opposite valley/spin character, enabling intrinsic, guided, and far reaching valley-polarized exciton currents.
Design of hybrid MoS2/photonic devices compatible with technological constraints
Authors: Dory Jean-Baptiste , Gauthier-Lafaye Olivier , Dubreuil Pascal , Massiot Inès , Calvez Stéphane , Mlayah Adnen
Published: February 2022

The integration of transition metal dichalcogenide layers into photonic devices is a current challenge in the field of 2D materials. Based on numerical simulations, this work explores the design of devices combining an MoS2 monolayer with planar photonic gratings sustaining localized optical resonances. A special attention is paid to the technological constraints. The optical response of six devices is compared taking into account the limitations imposed by the growth conditions of the MoS2 layer and the processing of the resonant optical gratings. The reported photonic devices composed of grating filters and a backside reflector on silicon and silica substrates exhibit a theoretical absorption by the MoS2 layer between 85 and 99% at 532 nm. The numerical simulations further show that the addition of an Al2O3 encapsulation layer, to protect the MoS2 monolayer, results in an increase of the performance of the devices. These hybrid MoS2 based photonic devices are promising technological platforms for the study of the optical properties of integrated MoS2 monolayers.
Excellent photocatalytic degradation and antibiosis of WO3/Fe2O3 heterojunction
Authors: Zhao Jing
Published: February 2022

The extensive light absorption, enhanced separation of photoinduced carriers and convenience of recycling are crucial for the practical application of WO3 photocatalyst in the dye degradation and the antibiosis activity. Hence, in this work, we synthesize WO3/Fe2O3 composite film on FTO conductive substrate through hydrothermal method. The higher degradation rate for methylene blue (MB) is achieved by WO3/Fe2O3 composite film, and the value of C/C0 is 0.28 which is lower than that of 0.58 for bare WO3 with the irradiation for 4 h. Moreover, the sterilization rate of 28.99% is achieved for WO3-based film with the deposition of Fe2O3 for 3 h. The deeper measurements indicate that the enhanced photocatalytic performances are attributed to the expand light absorption, improved transfer kinetics and separation efficiency of photoinduced carriers with the formation of heterojunction. This work establishes the effective template for WO3-based film with the enhanced photocatalytic prosperities for dye degradation and antibiosis.
Nanocrystalline structure and microhardness of cobalt-chromium alloys electrochemically synthesized using a metal hydroxide coprecipitation technique
Authors: Saeki Ryusei , Ohgai Takeshi
Published: February 2022

The effect of glycine as a complexing agent on metal hydroxide formation, such as Co(OH)2 and Cr(OH)3, was investigated based on potential-pH diagrams and titration curves for Co2+-H2O and Cr3+−H2O systems. Using a potentiostatic electrodeposition technique, Co–Cr alloy-based composite films containing Cr2O3 were synthesized from a non-suspended aqueous solution within an optimized pH range. Chromium content in the composite films was controlled up to 38.9% by adjusting the cathode potential during the alloy electrodeposition. Based on the XRD profiles and electron diffraction patterns, an amorphous-like nanocrystalline structure was observed in the composite films with high chromium content. The average crystal grain size declined due to Cr2O3 particles and hydrogen evolution during the electrodeposition process. Saturation magnetization of the composite films decreased with an increase in the chromium content. Synergistic contribution of increasing dislocation density and refining crystal grain size improved the microhardness of the composite films. The microhardness reached 624.2 kgf mm−2 and greatly exceeded that of pure cobalt (ca. 250–300 kgf mm−2).
Low doping in-situ strategy leading to polysilicon based TFTs exhibiting high stability under stress effects and enhanced electrical performances
Authors: Zaghdoudi Mariem , Rogel Régis , Mohammed-Brahim Tayeb
Published: February 2022

In the present work, we investigate the effect of low phosphorus doped polysilicon thin films. These later are deposited on glass substrates by low pressure chemical vapor Deposition (LPCVD) technique and are in situ doped with phosphine adjunction to silane. Doping levels are reported by the phosphine to silane ratio Γ varying from 0 (undoped layer) to heavily doped layer almost 1.2 × 10–3. Films are characterized by different techniques as Photothermal Deflection Spectroscopy (PDS), photoluminescence measurements and x-ray diffraction of polycrystalline layers. The last one reveals that doping concentration giving modification in crystallite size and presence of microstrain, so a clear reduction in the Eg value was observed for the slightest doped layer (Γ = 3.7 × 10–7) by comparaison with the undoped one ((Γ = 0). Results give evidence of an optimum doping level to obtain higher polysilicon films quality. Polysilicon film quality has been correlated to phosphorus doping levels. Thin film transistors (TFTs) are fabricated on glass substrate using a top gate four mask process at low temperature (<600 °C). Electrical characterizations highlight significant improvements in the TFTs performances using slightly doped film instead of undoped one as active layer. Based on Levinson’s model, density of states within the grain boundaries is also found to be the lowest. Stability under stress is enhanced too. For slightly doped films, electrical characterizations indicate that both threshold voltage

V

th

and density of states NT within the grain boundaries have their lowest values. Although, the field effect mobility μ records its highest values. Additionally, low doping levels enhances the TFT stability under stress. As a result, the in situ low doping strategy opens the way to manufacture polysilicon electronic devices exhibiting high electrical performances and a rather high stability under stress effects.
A combined multiscale modeling and experimental study on surface modification of high-volume micro-nanoparticles with atomic accuracy
Authors: Li Zoushuang , Xiang Junren , Liu Xiao , Li Xiaobo , Li Lijie , Shan Bin , Chen Rong
Published: February 2022

Surface modification for micro-nanoparticles at the atomic and close-to-atomic scales is of great importance to enhance their performance in various applications, including high-volume battery, persistent luminescence, etc. Fluidized bed atomic layer deposition (FB-ALD) is a promising atomic-scale manufacturing technology that offers ultrathin films on large amounts of particulate materials. Nevertheless, nanoparticles tend to agglomerate due to the strong cohesive forces, which is much unfavorable to the film conformality and also hinders their real applications. In this paper, the particle fluidization process in an ultrasonic vibration-assisted FB-ALD reactor is numerically investigated from micro-scale to macro-scale through the multiscale computational fluid dynamics and discrete element method (CFD-DEM) modeling with experimental verification. Various vibration amplitudes and frequencies are investigated in terms of their effects on the fluid dynamics, distribution of particle velocity and solid volume fraction, as well as the size of agglomerates. Results show that the fluid turbulent kinetic energy, which is the key power source for the particles to obtain the kinetic energy for overcoming the interparticle agglomeration forces, can be strengthened obviously by the ultrasonic vibration. Besides, the application of ultrasonic vibration is found to reduce the mean agglomerate size in the FB. This is bound to facilitate the heat transfer and precursor diffusion in the entire FB-ALD reactor and the agglomerates, which can largely shorten the coating time and improve the film conformality as well as precursor utilization. The simulation results also agree well with our battery experimental results, verifying the validity of the multiscale CFD-DEM model. This work has provided momentous guidance to the mass manufacturing of atomic-scale particle coating from lab-scale to industrial applications.
Graphical Ekeland’s principle for equilibrium problems
Authors: Alfuraidan Monther , Khamsi Mohamed
Published: February 2022

In this paper, we give a graphical version of the Ekeland’s variational principle (EVP) for equilibrium problems on weighted graphs. This version generalizes and includes other equilibrium types of EVP such as optimization, saddle point, fixed point and variational inequality ones. We also weaken the conditions on the class of bifunctions for which the variational principle holds by replacing the strong triangle inequality property by a below approximation of the bifunctions.
SmMIP-tools: a computational toolset for processing and analysis of single-molecule molecular inversion probes-derived data
Authors: Medeiros Jessie J F , Capo-Chichi Jose-Mario , Shlush Liran I , Dick John E , Arruda Andrea , Minden Mark D , Abelson Sagi
Published: February 2022

Motivation

Single-molecule molecular inversion probes (smMIPs) provide an exceptionally cost-effective and modular approach for routine or large-cohort next-generation sequencing. However, processing the derived raw data to generate highly accurate variants calls remains challenging.

Results

We introduce SmMIP-tools, a comprehensive computational method that promotes the detection of single nucleotide variants and short insertions and deletions from smMIP-based sequencing. Our approach delivered near-perfect performance when benchmarked against a set of known mutations in controlled experiments involving DNA dilutions and outperformed other commonly used computational methods for mutation detection. Comparison against clinically approved diagnostic testing of leukaemia patients demonstrated the ability to detect both previously reported variants and a set of pathogenic mutations that did not pass detection by clinical testing. Collectively, our results indicate that increased performance can be achieved when tailoring data processing and analysis to its related technology. The feasibility of using our method in research and clinical settings to benefit from low-cost smMIP technology is demonstrated.

Availability and implementation

The source code for SmMIP-tools, its manual and additional scripts aimed to foster large-scale data processing and analysis are all available on github (https://github.com/abelson-lab/smMIP-tools). Raw sequencing data generated in this study have been submitted to the European Genome-Phenome Archive (EGA; https://ega-archive.org) and can be accessed under accession number EGAS00001005359.

Supplementary information

Supplementary data are available at Bioinformatics online.
Grey matter network markers identify individuals with prodromal Alzheimer’s disease who will show rapid clinical decline
Authors: Pelkmans Wiesje , Vromen Ellen M. , Dicks Ellen , Scheltens Philip , Teunissen Charlotte E. , Barkhof Frederik , van der Flier Wiesje M. , Tijms Betty M. ,   for the Alzheimer’s Disease Neuroimaging Initiative
Published: February 2022

Individuals with prodromal Alzheimer’s disease show considerable variability in rates of cognitive decline, which hampers the ability to detect potential treatment effects in clinical trials. Prognostic markers to select those individuals who will decline rapidly within a trial time frame are needed. Brain network measures based on grey matter covariance patterns have been associated with future cognitive decline in Alzheimer’s disease. In this longitudinal cohort study, we investigated whether cut-offs for grey matter networks could be derived to detect fast disease progression at an individual level. We further tested whether detection was improved by adding other biomarkers known to be associated with future cognitive decline [i.e. CSF tau phosphorylated at threonine 181 (p-tau181) levels and hippocampal volume]. We selected individuals with mild cognitive impairment and abnormal CSF amyloid β1–42 levels from the Amsterdam Dementia Cohort and the Alzheimer’s Disease Neuroimaging Initiative, when they had available baseline structural MRI and clinical follow-up. The outcome was progression to dementia within 2 years. We determined prognostic cut-offs for grey matter network properties (gamma, lambda and small-world coefficient) using time-dependent receiver operating characteristic analysis in the Amsterdam Dementia Cohort. We tested the generalization of cut-offs in the Alzheimer’s Disease Neuroimaging Initiative, using logistic regression analysis and classification statistics. We further tested whether combining these with CSF p-tau181 and hippocampal volume improved the detection of fast decliners. We observed that within 2 years, 24.6% (Amsterdam Dementia Cohort, n = 244) and 34.0% (Alzheimer’s Disease Neuroimaging Initiative, n = 247) of prodromal Alzheimer’s disease patients progressed to dementia. Using the grey matter network cut-offs for progression, we could detect fast progressors with 65% accuracy in the Alzheimer’s Disease Neuroimaging Initiative. Combining grey matter network measures with CSF p-tau and hippocampal volume resulted in the best model fit for classification of rapid decliners, increasing detecting accuracy to 72%. These data suggest that single-subject grey matter connectivity networks indicative of a more random network organization can contribute to identifying prodromal Alzheimer’s disease individuals who will show rapid disease progression. Moreover, we found that combined with p-tau and hippocampal volume this resulted in the highest accuracy. This could facilitate clinical trials by increasing chances to detect effects on clinical outcome measures.
Enhancing well-being and social connectedness of rural communities through community shops
Authors: Finegan Trish , Cawley Buckley Morgan
Published: February 2022

This article evaluates the impact of a community development initiative to establish a network of community shops across County Kilkenny, Ireland. Specifically, this research investigates the impact of this initiative on community well-being in two localities. Data were gathered through multi-site semi-structured interviews with community workers and members. Respondents self-reported a perceptible improvement in individual and community well-being. The primary drivers of this process are identified as social connectedness, intergenerational contacts and emotional support. This research is an important early contribution to a relatively small body of research literature on community shops, particularly in Ireland. Furthermore, as community shops are increasingly recognized as effective resources in community development strategies, it is now critical to conduct analytical and qualitative work on their impact from the perspective of community member’s lived experience.
Navigating through the storm: conservancies as local institutions for regional resilience in Zambezi, Namibia
Authors: Hulke Carolin , Kalvelage Linus , Kairu Jim , Revilla Diez Javier , Rutina Lucas
Published: February 2022

The COVID-19 pandemic has disrupted global production networks and challenged the resilience of regional economies to external shocks. The tourism sector was severely affected by the travel bans imposed, as were regions characterised by tourism development, such as Zambezi in northern Namibia. Nonetheless, with the support of the national government, conservancies, as local governance institutions, partly maintained the distribution of value from tourism throughout the pandemic and strengthened agriculture-tourism linkages to achieve long-term transformation. These findings suggest that local institutions are able to create regional resilience through their capacity to drive adaptation and adaptability in a diversified regional economy.
The association between time to extracorporeal cardiopulmonary resuscitation and outcome in patients with out-of-hospital cardiac arrest
Authors: Kawakami Shoji , Tahara Yoshio , Koga Hidenobu , Noguchi Teruo , Inoue Shujiro , Yasuda Satoshi
Published: February 2022

Aims

Extracorporeal cardiopulmonary resuscitation (ECPR) is considered for potentially reversible out-of-hospital cardiac arrest (OHCA). However, the association between time to ECPR and outcome has not been well established.

Methods and results

Between June 2014 and December 2017, we enrolled 34 754 OHCA patients in a multicentre, prospective fashion [Japanese Association for Acute Medicine (JAAM)-OHCA registry]. After the application of exclusion criteria, 695 OHCA patients who underwent ECPR for cardiac causes were eligible for this study. We investigated the association between the call-to-ECPR interval and favourable neurological outcome (cerebral performance category 1 or 2) at 30 days. Seventy-seven patients (11%) had a favourable neurological outcome at 30 days. The call-to-ECPR intervals in these patients were significantly shorter than in those with an unfavourable neurological outcome [49 (41–58) vs. 58 (48–68) min, respectively, P < 0.001]. A longer call-to-ECPR interval was associated with a smaller proportion of patients undergoing percutaneous coronary intervention (PCI) (P = 0.034) or target temperature management (TTM) (P < 0.001). Stepwise multivariable logistic regression analysis revealed that the call-to-ECPR interval was an independent predictor of favourable neurological outcome [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.94–0.99, P = 0.001], as were age, male gender, initial shockable rhythm, transient return of spontaneous circulation in the prehospital setting, arterial pH at hospital arrival, PCI (OR 2.30, 95% CI 1.14–4.66, P = 0.019), and TTM (OR 2.28, 95% CI 1.13–4.62, P = 0.019).

Conclusion

A shorter call-to-ECPR interval and implementation of PCI and TTM predicted a favourable neurological outcome at 30 days in OHCA patients who underwent ECPR for cardiac causes.
Can Population III stars be major origins of both merging binary black holes and extremely metal poor stars?
Authors: Tanikawa Ataru , Chiaki Gen , Kinugawa Tomoya , Suwa Yudai , Tominaga Nozomu
Published: February 2022

Population (Pop) III stars, first stars, or metal-free stars are made of primordial gas. We have examined if they can be dominant origins of merging binary black holes (BHs) and extremely metal-poor (EMP) stars. The abundance pattern of EMP stars is helpful to trace back the properties of Pop III stars. We have confirmed previous arguments that the observed BH merger rate needs Pop III star formation efficiency 10 times larger than theoretically predicted values, while the cosmic reionization history still permits such a high Pop III star formation efficiency. On the other hand, we have newly found that the elemental abundance pattern of EMP stars only allows the Pop III initial mass function with the minimum mass of ∼15–27 M$_{\odot}$. In other words, the minimum mass must not deviate largely from the critical mass below and above which Pop III stars leave behind neutron stars and BHs, respectively. Pop III stars may still be a dominant origin of merging binary BHs but our study has reduced the allowed parameter space under the hypothesis that EMP stars are formed from primordial gas mixed with Pop III supernova ejecta.
Measurements of chromospheric Mg i emission lines of zero-age main-sequence stars
Authors: Yamashita Mai , Itoh Yoichi
Published: February 2022

The chromosphere is the active atmosphere in which energetic eruption events, such as flares, occur. Chromospheric activity is driven by the magnetic field generated by stellar rotation and convection. The relationship between chromospheric activity and the Rossby number, the ratio of the rotational period to the convective turnover time, has been extensively examined for many types of stars, by using narrow chromospheric emission lines, such as the Ca ii lines and the Mg ii H and K lines. However, the stars with small Rossby numbers, i.e., stars with rapid rotations and/or long convective turnover times, show constant strengths of such lines against the Rossby number. In this study, we investigate the infrared Mg i emission lines at 8807 Å of 47 zero-age main-sequence (ZAMS) stars in IC 2391 and IC 2602 using the archive data of the Anglo-Australian Telescope at the University College London Echelle Spectrograph. After subtracting the photospheric absorption component, the Mg i line is detected as an emission line for 45 ZAMS stars, the equivalent widths of which are between 0.02 Å and 0.52 Å. A total of 42 ZAMS stars show the narrower Mg i emission lines instead of the Ca ii infrared triplet emission lines, suggesting that they are formed at different depths. The ZAMS stars with smaller Rossby numbers show stronger Mg i emission lines. The Mg i emission line is not saturated even in the saturated regime of the Ca ii emission lines, i.e., Rossby number <10−1.1. The Mg i emission line is considered to be a good indicator of chromospheric activity, particularly for active objects.
Welfare and Redistribution in Residential Electricity Markets with Solar Power
Authors: Feger Fabian , Pavanini Nicola , Radulescu Doina
Published: February 2022

An increasing number of households installing solar panels and consuming the energy thus produced raises two challenges for regulators: network financing and vertical equity. We propose alternative tariff and subsidy designs for policymakers to incentivize solar panel adoptions and guarantee that network costs are recovered, while trading off efficiency, equity, and welfare motives. We estimate a structural model of energy demand and solar panel adoption, using a unique matched dataset on energy consumption, prices, income, wealth, solar panel installations, and building characteristics for 165,000 households in Switzerland from 2008 to 2014. Our counterfactuals recommend the optimal solar panel installation cost subsidies and two-part energy tariffs to achieve a solar energy target. We show that, relative to installation cost subsidies, relying on marginal prices to incentivize solar panel adoptions is more cost efficient and progressive across the income distribution, but generates a larger aggregate welfare loss.
Personalized management for unmet needs with food allergy
Authors: Miura Yoko , Yanagida Noriyuki , Sato Sakura , Ebisawa Motohiro
Published: February 2022

Purpose of review

Patients with food allergies are at risk of experiencing accidental allergic symptoms in real life. Low thresholds may be a risk factor for accidental allergic reactions. Therefore, the evaluation of this threshold is required for the management of food allergies. We have suggested a management approach to identify the threshold dose and the consumable dose, considering patient age and the severity of food allergies.

Recent findings

A younger age is a risk factor for accidental allergic reactions, and school-age children are likely to have a lower quality of life (QOL) than younger children. Additionally, patients with a low threshold may have difficulty in acquiring tolerance. We performed a stepwise oral food challenge (OFC) to evaluate the threshold and consumable doses for patients with food allergies. Performing a low-dose OFC for the first step would identify the dose that could be consumed at home safely and avoid the complete elimination of allergic foods. Identifying the threshold dose would be effective in managing the risk of accidental ingestion. For patients who react to low-dose OFC, low-dose oral immunotherapy (OIT) would be expected to prevent the experience of allergic reactions by accidental ingestion and consume medium doses safely.

For food allergy patients and their caregivers, identifying the consumable dose would help manage the diet and eliminate their anxiety. Low-dose OFC and low-dose OIT are effective and well tolerated, which would improve their QOL. Considering the severity of food allergy and age, determining a safe threshold with no reactions would meet the unmet needs of patients with food allergy.
Gender Influences in the Intersection of Acute Care Registered Nurses and Law Enforcement
Authors: Jenkins Danisha , Burton Candace , Holmes Dave
Published: February 2022

To give voice to the lived experiences of nurses and law enforcement officers who interact with one another in an acute care hospital setting, while gaining an understanding of individual perspectives and unique experiences, as well as how they interpret these experiences. This qualitative study used interpretative phenomenological analysis (IPA) to strive to meet the study objectives. There is a paucity of literature on the topic of nurse and law enforcement interaction in the hospital setting. Overwhelmingly, participants described a contentious dynamic between nurses and law enforcement officers in the hospital, wrought with argument, stress, and a feeling of coming from “different worlds.” The influence of gender was apparent to the female-identified participants, and gender constructs and therefore gender role conflict were critical points of contention. In exploring how nurses and law enforcement officers think about and describe their experiences, nurses and hospital systems may develop a deeper understanding and appreciation of barriers to care for incarcerated patients and of the challenging experiences nurses face in caring for these patients. The nurses' expressed feelings of intimidation, stress, and impaired self-efficacy in this dynamic underscore the need for institutional support and prioritization of caring practices, and identification of the ways in which carceral practices impair care, as well as nurses' safety.
3D Radiological Outcomes and Quality of Life of Patients With Moderate Idiopathic Scoliosis Treated With Anterior Vertebral Growth Modulation Versus Bracing: Two-Year Follow-up
Authors: Duarte Matias Pereira , Aubin Carl-Eric , Cobetto Nikita , Roy-Beaudry Marjolaine , Bellefleur Christian , Turgeon Isabelle , Labelle Hubert , Guy Aymeric , Barchi Soraya , Parent Stefan
Published: February 2022

Study Design.

Observational cohort study.

Objective.

To test the hypothesis that anterior vertebral body growth modulation (AVBGM) achieves 3D deformity correction after 2-year follow-up while brace treatment limits curve progression for moderate idiopathic scoliosis (30–50°).

Summary of Background Data.

For idiopathic scoliosis, bracing and AVBGM have overlapping indications in skeletally immature patients with moderate scoliosis curve angles, creating a grey zone in clinical practice between them. The relative 3D deformity control performance over a 2-year period between these fusionless treatments is still uncertain.

Methods.

A retrospective review of a prospective idiopathic scoliosis patients database, recruited between 2013 and 2018 was performed. Inclusion criteria were skeletally immature patients (Risser 0–2), with Cobb angles between 30° and 50° and a 2-year follow-up after bracing or AVBGM. 3D radiological parameters and health related quality of life (HRQoL) scores were evaluated. Unpaired t test was used.

Results.

Thirty nine patients (12.7 ± 1.3 y.o.) with Cobb angles more than or equal to 30° treated with brace and 41 patients (11.8 ± 1.2 y.o.) with presenting Cobb angles less than or equal to 50° who received AVBGM were reviewed. The statistical analysis of 3D deformity measurements showed that at 2-year follow-up, only the 3D spine length and both sides apical vertebral heights changed significantly with brace treatment. While AVBGM treatment achieved statistically significant correction differences in thoracic and lumbar Cobb angles, TrueKyphosis, 3D spine length, and selective left apical vertebral height (P< 0.05). 35% of brace patients had a curve progression of more than 5° at final follow-up while it was 0% for AVBGM. HRQoL assessment showed no statistically significant differences between pre and post SRS-22 total scores for each group (P > 0.05).

Conclusion.

Even though these two cohorts are not fully comparable, bracing seems to control progression for a significant portion of patients with moderate scoliosis curves, while AVBGM significantly corrected and maintained 3D deformity parameters at 2-year follow-up.
Compromised Integrity, Burnout, and Intent to Leave the Job in Critical Care Nurses and Physicians
Authors: LeClaire Michele , Poplau Sara , Linzer Mark , Brown Roger , Sinsky Christine
Published: February 2022

OBJECTIVES:

To describe relationships between compromised integrity (CI), burnout, and intent-to-leave (ITL) practice in critical care (CC) and noncritical care (non-CC) nurses and physicians.

DESIGN:

CC nurses (RNs) and physicians (MDs) from the American Medical Association Coping with COVID survey were matched by gender, race, years in practice, and role with non-CC clinicians to determine likelihood of ITL in relation to burnout and CI.

SETTING:

U.S. Healthcare organizations; July—December 2020.

SUBJECTS:

One hundred sixty-five CC RNs and 148 CC MDs (n = 313) matched with 165 non-CC RNs and 148 non-CC MDs from 83 healthcare organizations.

MEASUREMENTS AND MAIN RESULTS:

Burnout was measured with a single, validated question that mainly reflects emotional exhaustion (EE), and CI was determined by asking if respondents worried about doing things that compromised their integrity moderately or to a great extent. ITL included those moderately, likely, or definitely, intending to leave. Burnout correlated strongly with CI (tetrachoric r = 0.704 [0.606–0.803]; P < 0.001). Of 626 subjects, 59% experienced burnout, 24% CI, and 33% ITL. CC RNs experienced burnout more often (76%) than non-CC RNs (62%; P < 0.01) and CC MDs (51%; P < 0.001). CI was more frequent in CC RNs (44%) than non-CC RNs (23%) and CC MDs (16%; P < 0.001). In multivariate regressions, CC clinicians experiencing burnout had 50% greater odds of ITL than non-CC clinicians experiencing burnout; odds of ITL were substantially higher (odds ratio, 2.8–3.2) in those with CI regardless of location or burnout. In the ICU, those feeling valued by their organization had one-third the odds of ITL.

CONCLUSIONS:

Burnout (EE) is high (>50%) among CC RNs and MDs, which may result in losses of CC clinicians while demand rises. Preventing CI independent of burnout may reduce turnover in all settings and especially in ICUs. Feeling valued may promote staff retention.
Stereotactic Body Radiotherapy and Systemic Dose Chemotherapy for Locally Advanced Lung Cancer
Authors: Kubicek Gregory J. , Khrizman Polina , Squillante Christian , Callahan Kevin , Xu Qianyi , Abouzgheib Wissam , Boujaoude Ziad , Patel Ashish , Hageboutros Alexander
Published: February 2022

Purpose:

This is a single arm phase 2 study (Clinical trials.gov NCT02568033) to examine the role of stereotactic body radiotherapy (SBRT) along with full dose systemic chemotherapy in the treatment of unresectable stage 2 and stage 3 nonsmall cell lung cancer. Primary endpoints are disease free survival and toxicity.

Materials:

Patients were treated with SBRT to all sites of gross disease. Dosing consisted of 60 Gy in 3 fractions for peripheral lung tumors, 50 Gy in 5 fractions for central lung tumors, and 40 to 50 Gy in 5 fractions for hilar and mediastinal lymph nodes. Chemotherapy consisted of 4 cycles of pemetrexed and cisplatin or carboplatin and paclitaxel for nonsquamous histology and cisplatin and docetaxel or cisplatin and paclitaxel for squamous histology. SBRT was given in between the chemotherapy cycles. There was a 7 days break between chemotherapy and SBRT. Quality of life was measured using functional assessment of cancer therapy-lung.

Results:

Twenty two patients were enrolled and analyzed. Seventeen (77%) were stage III and 19 (86%) had lymph node involvement. Median follow-up for all patients was 23.1 months. Median overall survival is 27.2 months. Overall survival at 1 year was 82% and overall survival at 2 years was 53%. Median disease free survival is 16.0 months with a 2-year regional failure rate of 19% and 2-year distant failure rate of 47.2%. There were 6 grade 3 acute toxicities and 2 late grade 3 or higher toxicities including 1 grade 5 hemoptysis. Quality of life scores were unchanged compared with baseline.

Conclusion:

A combination of SBRT and full dose chemotherapy appears to be a safe and effective treatment for locally advanced NSCLC and warrants further investigation.
Short-Term Follow-Up of a Randomized Controlled Trial of 0.5% and 5% 5-Fluorouracil After Microneedling for Treatment of Facial Actinic Keratoses
Authors: Kalil Célia Luiza Petersen Vitello , Reinehr Clarissa Prieto Herman , Bakos Renato Marchiori
Published: February 2022

INTRODUCTION

Topical 5-fluorouracil (5-FU) is used to treat actinic keratosis, although side effects limit treatment. Microneedling might be a tool for reducing treatment duration.

OBJECTIVE

To evaluate microneedling to promote 5-FU delivery at different concentrations (0.5% and 5%) for actinic keratoses (AKs) treatment.

METHODS

Forty-four patients with facial AKs subjected to 1.0 mm microneedling on 1 side of the face were randomized into 5% 5-FU or 0.5% 5-FU groups. Evaluations of efficacy and safety were conducted on days 21 and 111.

RESULTS

Forty-four patients aged 47 to 85 years were enrolled. Complete clearance of AKs was similar within groups for the side of the face treated with microneedling and 5-FU and the side treated with 5-FU alone in both the 5% and 0.5% 5-FU groups. Microneedling and 5% 5-FU was superior to microneedling and 0.5% 5-FU to reduce AKs (p = .025). Microneedling and 5% 5-FU resulted in fewer adverse effects than 5% 5-FU alone (p = .011).

CONCLUSION

Topical 5% and 0.5% 5-FU delivery for 3 days after microneedling was effective for treating facial AKs and equivalent to 5% and 0.5% 5-FU alone for 15 days after 3 months of follow-up. Microneedling may potentiate 5-FU treatment, reducing treatment time without losing efficacy.
SURGICAL OUTCOME AND PROGNOSTIC FACTORS AFTER OPHTHALMIC SURGERY IN ABUSIVE HEAD TRAUMA
Authors: Ho Ming-Chih , Wu An-Lun , Wang Nan-Kai , Chen Kuan-Jen , Hwang Yih-Shiou , Lai Chi-Chun , Wu Wei-Chi
Published: February 2022

Purpose:

To analyze the clinical characteristics, surgical outcomes, and risk factors associated with visual outcomes in patients with abusive head trauma (AHT).

Methods:

We retrospectively reviewed surgical outcomes of patients with AHT who underwent vitrectomy from 2001 to 2019. The patients' demographics, comprehensive preoperative and postoperative ocular findings, surgical treatments, visual outcomes, and postoperative complications in the medical records were reviewed. Univariable and multivariable analyses were performed to identify the prognostic factors associated with visual outcomes.

Results:

Fourteen children (18 eyes) diagnosed with AHT who underwent vitrectomy were evaluated. The most common surgical indication was vitreous hemorrhage (n = 6, 33%). Retinal attachment at the final visit was noted in 17 eyes (94%). Thirteen eyes (72%) had a best-corrected visual acuity less than 20/200 after vitrectomy. In the multivariable analysis, optic nerve atrophy (n = 9, 50%) was significantly associated with a poor visual prognosis (final best-corrected visual acuity worse than 20/200) after vitrectomy in children with AHT (95% confidence interval, 1.041–517.963, P = 0.0471).

Conclusion:

The general visual prognosis was poor for patients with AHT needing vitrectomy, although a high rate of retinal attachment was observed. Optic nerve atrophy is a prognostic factor for poor visual outcomes in patients with AHT who received ophthalmic surgery.
PRESUMPTIVE RECURRENCE OF INTRAOCULAR LYMPHOMA DESPITE CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY
Authors: Taher Amir , Abadir Edward , McCluskey Peter , Hamad Nada , Lo Tsun-Ho , Heydon Peter
Published: February 2022

Purpose:

To present the first reported case of presumptive intraocular recurrence of lymphoma following Chimeric Antigen Receptor (CAR) T-cell therapy despite systemic control by CD19-CAR T cells.

Methods:

Observational case report.

Results:

A 59-year-old man with diffuse, large, B-cell lymphoma subsequently developed secondary central nervous system disease despite chemotherapy. He underwent stem cell transplantation but relapsed again and was scheduled to receive CAR T-cell therapy. He developed vitritis several weeks before treatment, with vitreous biopsy showing non-Hodgkin B-cell lymphoma. He received CAR T-cell therapy following the vitrectomy. He presented 3 months following CAR T-cell therapy with nonspecific right eye floaters and discomfort, with the optical coherence tomography revealing subretinal saw-tooth deposits in the right eye, highly suggestive of lymphoma. This is despite having good systemic control with no other disease elsewhere in the body. He received intravitreal methotrexate to good effect.

Conclusion:

To our knowledge, this is the first case of a vitreoretinal lymphoma nonresponsive to CAR T-cell therapy, despite good central nervous system and systemic control. This is suggestive of anti-CD19 CAR T cells not trafficking into the eye in sufficient numbers to eliminate CD19-expressing neoplastic B cells. We suggest regular ophthalmic follow-up after CAR-T-cell therapy for patients where there is evidence of ocular involvement.
The gut barrier and chronic diseases
Authors: Santilli Anthony , Stefanopoulos Stavros , Cresci Gail A.M.
Published: February 2022

Purpose of review

The purpose of this review is to provide an update regarding the gut barrier and its involvement with chronic diseases, as well as to review biomarkers for identification of gut barrier integrity. This review is timely and relevant as our knowledge is increasing regarding the role of the gut microbiome and the gut barrier in health and disease.

Recent findings

This review provides an overview of: the gut barrier, which is complex and comprised of the mucus layer and the intestinal apical junctional protein complex; the gut microbiome in its relation to regulating the integrity of the gut barrier; select acute and chronic conditions that are known to be associated with gut dysbiosis and impaired gut integrity or ‘leaky gut’; and current means for identifying loss in gut barrier integrity.

Many chronic conditions are associated with gut dysbiosis and systemic inflammation. Identifying whether the gut barrier is compromised in these conditions could help to inform potential therapeutics as a means to correct losses in gut barrier integrity and mitigate associated medical conditions.
Differential diagnosis of dysosmia and dysgeusia in COVID-19 pandemic setting
Authors: Minowa Kenji , Ogawa Fumihiro , Takahashi Mitsuru , Yokoi Hideto , Gakumazawa Masayasu , Doi Tomoki , Takeuchi Ichiro
Published: February 2022

Introduction:

Among the initial symptoms of coronavirus disease 2019, typical viral infection symptoms such as fever and respiratory symptoms appear, but dysgeusia and olfactory disorders has also been reported. However, many diseases cause dysgeusia, and care must be taken during differentiation.

Patient Concerns:

A 76-year-old man presented to our hospital with continuous fever, dysgeusia, dysosmia, and vomiting.

Diagnosis:

A chest radiograph showed an infiltrative shadow in the right hilar region, and the patient was hospitalized with suspected coronavirus disease 2019. Computed tomography of the chest revealed a mass lesion in the upper right lobe without ground-glass opacities or consolidations. However, head computed tomography revealed a mass lesion in the right frontal lobe, suggesting a malignant tumor. The coronavirus disease 2019 polymerase chain reaction test was negative, and pathological results confirmed lung adenocarcinoma. Therefore, the diagnosis was lung adenocarcinoma and brain metastasis from lung cancer with dysgeusia and dysosmia.

Interventions:

The patient was treated with antibiotics for suspected pneumonia, brain tumor by whole-brain radiotherapy, and peripheral edema around the brain tumor was treated with concentrated glycerin and corticosteroids.

Outcomes:

After the start of aggressive treatment for his symptoms (except chemotherapy), his condition deteriorated sharply, making it impossible to continue aggressive treatment. Sixteen days after admission, he died of liver dysfunction and massive lung cancer. Throughout the clinical course, the patient had persistent dysgeusia and dysosmia.

Conclusion:

Dysosmia and dysgeusia are suspected to be typical symptoms of coronavirus disease 2019, but other diseases also cause these symptoms. Hence, in this pandemic setting, it is important not to overlook diseases that can result in poor outcomes.
Heterotopic ossification in COVID-19 patient on anticoagulation with limited treatment options
Authors: Van Ochten Natalie A. , Shori Akhil , Puderbaugh Matthew A. , Benert Joseph , Krishnamurthy Murali
Published: February 2022

Introduction:

There is limited research on the treatment of heterotopic ossification in patients with contraindications to nonsteroidal anti-inflammatory drugs.

Patient concerns:

A 59-year-old man with a past medical history of diabetes, hypertension, and recurrent pulmonary embolism on anticoagulation (apixaban 5 mg twice a day) presented to the emergency department with dyspnea and was noted to have bilateral pleural effusion and severe acute respiratory syndrome coronavirus 2. The patient was admitted for coronavirus disease 2019 treatment and was subsequently intubated. While intubated, he received physical therapy and had progressive hip pain by day 23, which interfered with therapy. Computed tomography of the abdomen and pelvis on day 30 of intubation showed no significant bony abnormalities. He was extubated after 43 days, stabilized, and admitted for acute rehabilitation for intensive care unit-associated weakness 15 days later. He continued to experience worsening hip pain.

Diagnosis:

Bilateral hip radiographs were obtained on rehabilitation day 35 (day 103 of overall hospitalization), which demonstrated Booker Grade 3 heterotopic ossification on the right and Booker Grade 2 on the left.

Interventions:

A multidisciplinary approach to treatment was sought using consultants from orthopedics, endocrinology, radiation oncology, pharmacy, and physical therapy. Owing to his anticoagulation status, nonsteroidal anti-inflammatory drugs were not recommended. Radiation therapy and bisphosphonates are also not recommended. The patient's pain was managed with tylenol as needed and tizanidine.

Outcomes:

Tylenol and tizanidine were effective in controlling pain and allowing the patient to participate in therapies. He had no treatment-related complications.

Conclusion:

Prolonged intubation and intensive care unit stay are risk factors for heterotopic ossification development and should be considered early on admission. Prompt identification and early treatment with an aggressive range of motion should be considered. This case exemplifies the challenges of treating heterotopic ossification in patients with severe coronavirus disease 2019 and contraindications to further anticoagulation.
MYO5B Gene Mutations
Authors: Matarazzo Lorenza , Bianco Anna Monica , Athanasakis Emmanouil , Serveres Marco , Francalanci Paola , Cenacchi Giovanna , Maggiore Giuseppe , D'Adamo Adamo Pio
Published: February 2022

Objectives:

Progressive familial intrahepatic cholestasis is an expanding group of autosomal recessive intrahepatic cholestatic disorders. Recently, next‐generation sequencing allowed identifying new genes responsible for new specific disorders. Two biochemical phenotypes have been identified according to gamma‐glutamyltransferase (GGT) activity. Mutations of the myosin 5B gene (MYO5B) are known to cause microvillus inclusion disease. Recently, different mutations in MYO5B gene have been reported in patients with low‐GGT cholestasis.

Methods:

A multicenter retrospective and prospective study was conducted in 32 children with cryptogenic intrahepatic cholestasis. Clinical, biochemical, histological, and treatment data were analyzed in these patients. DNA from peripheral blood was extracted, and all patients were studied by whole exome sequencing followed by Sanger sequencing.

Results:

Six patients out of 32 had mutations in the MYO5B gene. Of these six patients, the median age at disease onset was 0.8 years, and the median length of follow‐up was 4.2 years. The most common signs were pruritus, poor growth, hepatomegaly, jaundice, and hypocholic stools. Two patients also showed intestinal involvement. Transaminases and conjugated bilirubin were moderately increased, serum bile acids elevated, and GGT persistently normal. At anti‐Myo5B immunostaining, performed in liver biopsy of two patients, coarse granules were evident within the cytoplasm of hepatocytes while bile salt export pump was normally expressed at the canalicular membrane. Six variants in homozygosity or compound heterozygosity in the MYO5B gene were identified, and three of them have never been described before. All nucleotide alterations were located on the myosin motor domain except one missense variant found in the isoleucine‐glutamine calmodulin‐binding motif.

Conclusions:

We identified causative mutations in MYO5B in 18.7% of a selected cohort of patients with intrahepatic cholestasis confirming a relevant role for the MYO5B gene in low‐GGT cholestasis.
Abatacept-based Graft-Versus-Host Disease Prophylaxis in Haplo-identical Hematopoietic Cell Transplant in a High-risk Cohort
Authors: Raffa Enass H. , Srinivasan Anand , Wall Donna A. , Schechter Tal , Ali Muhammad , Krueger Joerg , Chiang Kuang-Yueh
Published: February 2022

Background:

There is insufficient guidance in using posttransplant cyclophosphamide in patients with organ dysfunctions. Abatacept (Aba), a T cell costimulation blockade, has recently been shown to prevent severe acute graft-versus-host disease (GVHD).

Observation:

We report adding Aba as GVHD prophylaxis in 4 pediatrics patients who received haplo-hematopoietic cell transplantation. Two patients had grade 2 acute GVHD and 2 had mild chronic GVHD. All 4 patients are alive with full donor chimerism, and 3 are off immunosuppressants.

Conclusion:

An Aba-based regimen can result in reliable engraftment and acceptable GVHD when concerns of organ dysfunction prevents the use of posttransplant cyclophosphamide in haplo-hematopoietic cell transplantation.