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Support for a patient in the aftermath of a potentially traumatic event is enhanced when clinicians understand the normal reactions that may occur during the traumatization process. This article discusses recommendations from international and national guidelines as well as best practices from the medical and psychiatric literature to help guide clinicians providing care for acutely traumatized patients.

We assessed two approaches for determining shell thicknesses of core–shell nanoparticles (NPs) by X-ray photoelectron spectroscopy (XPS). These assessments were based on simulations of photoelectron peak intensities for Au-core/C-shell, C-core/Au-shell, Cu-core/Al-shell, and Al-core/Cu-shell NPs with a wide range of core diameters and shell thicknesses. First, we demonstrated the validity of an empirical equation developed by Shard for determinations of shell thicknesses. Values of shell thicknesses from the Shard equation typically agreed with actual shell thicknesses to better than 10%. Second, we investigated the magnitudes of elastic-scattering effects on photoelectron peak intensities by performing a similar series of simulations with elastic scattering switched off in our simulation software. Our ratios of the C-shell 1s intensity to the Au-core 4f7/2intensity with elastic scattering switched off were qualitatively similar to those obtained by Torelli et al. from a model that neglected elastic scattering. With elastic scattering switched on, the C 1s/Au 4f7/2intensity ratios generally changed by less than 10%, thereby justifying the neglect of elastic scattering in XPS models that are applied to organic ligands on Au-core NPs. Nevertheless, elastic-scattering effects on peak-intensity ratios were generally much stronger for C-core/Au-shell, Al-core/Cu-shell, and Cu-core/Al-shell NPs, and there were second-order dependences on core diameter and shell thickness.

Molecular glasses indomethacin and ortho-terphenyl were formed and fractured by cooling a liquid on a less thermally expansive substrate. In-plane tension was created by the mismatch of thermal expansion coefficients and accumulated to cause catastrophic network fracture. Differential scanning calorimetry was used to characterize the process. The heat of fracture exceeds by 10 times the strain energy released, and matches the excess enthalpy stored by an elastic film that is cooled under lateral constraint. The constrained film has a smaller heat capacity than a free-standing film, by approximately 0.01 J/g/K or 1%. This allows the constrained film to reach higher enthalpy on cooling and the excess enthalpy is released at fracture.

The case being presented is a 35-year-old female with a 3-year history of progressive dyspnea and right-sided heart failure following spine surgery. Physical examination identified a continuous bruit in the lower abdomen radiating to her back which prompted further evaluation. Echocardiography showed normal left ventricle systolic function, enlarged right ventricle, functional tricuspid regurgitation, and moderate pulmonary hypertension. A computed tomography (CT) scan of the abdomen and pelvis demonstrated findings consistent with an arteriovenous fistula (AVF) between the right common iliac artery and the inferior vena cava. She underwent an uneventful endovascular repair without perioperative complication. The patient's symptoms resolved a few hours after the procedure and she continued to be symptom free at 3-month follow-up. This case illustrates an iatrogenic iliocaval fistula causing high-output cardiac failure which was successfully treated endovascularly with excellent clinical result.

We evaluated two methods for determining shell thicknesses of core–shell nanoparticles (NPs) by X-ray photoelectron spectroscopy. One of these methods had been developed for determining thicknesses of films on a planar substrate while the other was developed specifically for NPs. Our evaluations were based on simulated Cu 2p3/2spectra from Cu-core/Cu-shell NPs with a wide range of core diameters and shell thicknesses. Copper was chosen for our tests because elastic-scattering effects for Cu 2p3/2photoelectrons excited by Al Kα X-rays are known to be strong. Elastic scattering could also be switched off in our simulations so that the two methods could be evaluated in the limit of no elastic scattering. We found that the first method, based on both core and shell photoelectron intensities, was unsatisfactory for all conditions. The second method, based on an empirical equation for NPs developed by Shard, also utilized both core and shell photoelectron intensities and was found to be satisfactory for all conditions. The average deviation between shell thicknesses derived from the Shard equation and the true values was −4.1% when elastic scattering was switched on and −2.2% when elastic scattering was switched off. If elastic scattering was switched on, the effective attenuation length for a Cu film on a planar substrate was the appropriate length parameter while the inelastic mean free path was the appropriate parameter when elastic scattering was switched off.

IMPORTANCE: Optimal chemotherapy dosing in obese patients remains uncertain, with variation in practice. Dose reduction strategies are often used to avoid chemotoxicity, but recent American Society of Clinical Oncology guidelines recommend full dose. OBJECTIVE: To evaluate the impact of body mass index (BMI) on chemotherapy dosing and of dose reduction on ovarian cancer survival. DESIGN, SETTING, AND PARTICIPANTS: Cohort study in Kaiser Permanente Northern California (KPNC) health care setting of patients with primary invasive epithelial ovarian cancers diagnosed from January 2000 through March 2013. Analyses focused on 806 patients receiving adjuvant first-line therapy of carboplatin and paclitaxel with curative intent. MAIN OUTCOMES AND MEASURES: Overall and ovarian cancer–specific mortality. Deaths were identified through the KPNC Mortality Linkage System, with median follow-up of 52.5 months. Hazard ratios (HRs) and 95% CIs were estimated from proportional hazards regression, accounting for prognostic variables including age at diagnosis, race, stage, grade, histologic type, chemotoxic effects, comorbidities, cancer antigen 125 levels, and BMI at diagnosis. RESULTS: The strongest predictor of dose reduction was a high BMI. Compared with normal-weight women, obese class III women received 38% and 45% lower doses in milligrams per kilogram of body weight of paclitaxel and carboplatin, respectively (P < .001 for each agent). They also received lower relative dose intensity (RDI) for each agent and the combined regimen, calculated as average RDI (ARDI). Mean ARDI was 73.7% for obese class III women and 88.2% for normal-weight women (P < .001). Lower ARDI (<70%) was associated with worse overall (HR, 1.62 [95% CI, 1.10-2.37]) and ovarian cancer–specific survival (HR, 1.69 [95% CI, 1.12-2.55]). Women who were obese at diagnosis appeared to have better survival. In multivariable-adjusted analyses considering joint effects by BMI and ARDI, compared with women with normal weight and no dose reduction, normal-weight women with dose reduction (ARDI < 85%) experienced worse survival (HR, 1.50 [95% CI, 1.02-2.21]). For each BMI category, those with ARDI less than 85% had worse survival than those without dose reduction. The improved survival among obese women was no longer apparent with dose reduction. CONCLUSIONS AND RELEVANCE: Lower RDI was an independent predictor of ovarian cancer mortality. This finding was strongest among normal-weight women but seen at all levels of BMI. Our results suggest that body size should not be a major factor influencing dose reduction decisions in women with ovarian cancer.

The functionality of a new version of the National Institute of Standards and Technology Database for the Simulation of Electron Spectra for Surface Analysis (SESSA) (Werner, W. S. M.; et al. U.S. Department of Commerce/NIST: Gaithersburg, Maryland,2014) has been extended by implementing a new geometry engine. The engine enables users to simulate Auger-electron spectra and X-ray photoelectron spectra for different predefined morphologies (planar, islands, spheres, multilayer core–shell particles). We compared shell thicknesses of core–shell nanoparticles derived from core–shell XPS peak intensities using Shard’s method, which allows one to estimate shell thicknesses of core–shell nanoparticles, and a series of SESSA simulations for a wide range of nanoparticle dimensions. We obtained very good agreement of the shell thicknesses for cases where elastic scattering within the shell can be neglected, a result that is in accordance with the underlying assumptions of the Shard model. If elastic-scattering effects are important, there can be thickness uncertainties of up to 25%. Experimental spectra of functionalized gold nanoparticles obtained by Techane et al. were analyzed with SESSA 2.0 both with respect to the relevant peak intensities as well as the spectral shape. Good agreement between experiment and theory was found for both cases. These results show that the single-sphere model for core–shell nanoparticles is valid when just using peak intensities, but more detailed modeling is needed to describe the inelastic background.

Within the field of organ donation, multiple studies have shown differences in patterns of trust, however, it is unclear which elements are significantly related to donation decision making among African Americans. This study sought to disentangle the construct of trust by parceling out measures related to the healthcare system, the donation/allocation system, and the physician; and determine the relationship of these dimensions to attitudes toward organ and tissue donation. Cross-sectional survey data were gathered from 585 African American adults residing in the Atlanta metropolitan area. Results indicate that varying dimensions of trust function differently in their influence on attitudes toward donation. Our findings suggest that trust is critical to donation decision-making and should be measured with a multidimensional approach, particularly among racial/ethnic groups with complex histories with the healthcare system. This study underlines the need for a more tailored, individualized approach to promoting organ and tissue donation among African Americans.

Diabetes mellitus is well known to cause bladder dysfunction; however, the molecular mechanisms governing this process and the effects on individual tissue elements within the bladder are poorly understood, particularly in type 2 diabetes. A shotgun proteomics approach was applied to identify proteins differentially expressed between type 2 diabetic (TallyHo) and control (SWR/J) mice in the bladder smooth muscle and urothelium, separately. We were able to identify 1760 nonredundant proteins from the detrusor smooth muscle and 3169 nonredundant proteins from urothelium. Pathway and network analysis of significantly dysregulated proteins was conducted to investigate the molecular processes associated with diabetes. This pinpointed ERK1/2 signaling as a key regulatory node in the diabetes-induced pathophysiology for both tissue types. The detrusor muscle samples showed diabetes-induced increased tissue remodeling-type events such as Actin Cytoskeleton Signaling and Signaling by Rho Family GTPases. The diabetic urothelium samples exhibited oxidative stress responses, as seen in the suppression of protein expression for key players in the NRF2-Mediated Oxidative Stress Response pathway. These results suggest that diabetes induced elevated inflammatory responses, oxidative stress, and tissue remodeling are involved in the development of tissue specific diabetic bladder dysfunctions. Validation of signaling dysregulation as a function of diabetes was performed using Western blotting. These data illustrated changes in ERK1/2 phosphorylation as a function of diabetes, with significant decreases in diabetes-associated phosphorylation in urothelium, but the opposite effect in detrusor muscle. These data highlight the importance of understanding tissue specific effects of disease process in understanding pathophysiology in complex disease and pave the way for future studies to better understand important molecular targets in reversing bladder dysfunction.

As the testing criteria for BRCA expand, we are identifying a greater number of young women at significant risk for breast and ovarian cancer. Fortunately, there is strong evidence to support risk reduction from mastectomy and oophorectomy. However, these surgeries come with significant psychological and physical health consequences. For breast cancer, screening with mammogram and magnetic resonance imaging may be a reasonable approach for a woman who does not desire surgery. However, there is no evidence to suggest any efficacy in screening for ovarian cancer, and women electing to not undergo surgery must have a detailed discussion with their physician regarding the risks and benefits of different management strategies. As more women are electing to undergo surgical risk reduction, providers must also be able to counsel and care for these women who will face unique health challenges after surgical menopause at a young age. A review of the current evidence behind management of the BRCA woman follows, with a focus on areas of controversy and current research.

Purpose:The aim of this article is to describe cancer risk–reducing behaviors of women with BRCA variants of unknown significance.Methods:A retrospective chart review from 1995 to 2012 identified women with BRCA mutations in a northern California community system. Exclusion criteria included loss of membership/death within 1 year of testing, prior ovarian cancer, or bilateral salpingo-oophorectomy. Primary outcomes were rate of risk-reducing mastectomy and risk-reducing salpingo-oophorectomy.Results:The mean age of the 69 variant of unknown significance carriers was 50 vs. 47 years for the 305 women with a deleterious mutation. Women with a variant of unknown significance were followed for a median of 69 months. Among women with a variant of unknown significance, 30% underwent risk-reducing salpingo-oophorectomy and 11% underwent risk-reducing mastectomy, as compared with 74 and 44%, respectively, for women with a deleterious mutation. Women with a deleterious mutation were more likely to undergo surveillance in the first year after testing. The odds ratios are as follows: 2.1 for mammogram, 6.0 for magnetic resonance imaging, 7.7 for Ca-125, and 5.0 for transvaginal ultrasound. Fifty-six percent of women with a variant of unknown significance were reclassified after a median of 39 months, longer than the median time to risk-reducing salpingo-oophorectomy (18.6 months) or risk-reducing mastectomy (20.1 months).Conclusion:Uptake of risk-reducing strategies among women with a variant of unknown significance is lower than among women with a deleterious mutation. Given the prognostic uncertainty and high rate of reclassification for women with a variant of unknown significance, individualizing counseling and directing efforts toward surveillance, chemoprevention, or salpingectomy are recommended.Genet Med 16 12, 896–902.

Context Despite numerous benefits of live donor kidney transplant (LDKT), patient-level barriers often prevent African Americans from considering LDKT. Educational interventions designed to address patient-level barriers may increase willingness among African American patients with end-stage renal disease to explore LDKT as a treatment option.Objective To assess the effectiveness of a culturally sensitive educational intervention called Living ACTS (About Choices in Transplantation and Sharing) that was designed to address patient-level barriers to LDKT among African American patients with end-stage renal disease.Design/Participants Patients were randomized to intervention (n = 136) or control (n=132) groups. They completed baseline measures and then viewed either the Living ACTS or control video. Both groups then completed an immediate follow-up measure and a 6-month assessment administered via telephone.Main Outcome Measures Self-reported knowledge about LDKT, willingness to talk to the patient's family about LDKT, and perceived benefits of LDKT were measured at 3 time points.Results At 6-month follow-up, intervention participants demonstrated a significantly greater increase in knowledge of LDKT than control participants (F2,229= 3.08, P= .05). Intervention participants expressed greater willingness to talk to patients' families about LDKT than did control participants from baseline through 6-month follow-up (F1,230= 7.11, P= .008). Finally, at immediate follow-up, intervention participants reported greater endorsement of the benefits of LDKT than did control participants (F2,223= 14.27, P< .001); however, this effect had disappeared by the 6-month follow-up.Conclusions Living ACTS is effective at increasing and maintaining knowledge about LDKT among African American patients with end-stage renal disease who are considering transplant.

A first set of shock propagation, laser-plasma interaction, hohlraum energetics and hydrodynamic experiments have been performed using the first 4 beams of the National Ignition Facility (NIF), in support of indirect drive Inertial Confinement Fusion (ICF) and High Energy Density Physics.

Peripheral thrombolysis is an indispensible tool in the treatment of occlusive peripheral vascular disease (PVD). However, the use of intravascular thrombolytic agents carries a significant risk of morbidity and mortality. The aim of this study is to review a contemporary series of patients treated with catheter-directed thrombolytics in the treatment of occlusive PVD.

The linking of orthopalladated ferrocenylene units by parabanato2– ligands results in enantiospecific assembly of a hexanuclear complex in which i the steric bulk of the ferrocenylene moiety, ii the folded configuration dictated by the imidato2– bridging ligand, and iii the strong preference for a transarrangement of the carbonyl oxygen and ferrocenyl carbon atoms, combine to ensure that only ferrocenylenepalladium units with the same chirality can be located at adjacent positions in the assembled complex. The resulting trisparabanato2–bridged, hexapalladium complex is thus homochiral R,R,R,R,R,Ror S,S,S,S,S,S, as demonstrated by 1H NMR spectroscopy and by Xray analysis of a racemic crystal which shows the complex to possess a tapering, twisted, trigonalprismatic skeleton of palladium atoms with threefold crystallographic symmetry.© WileyVCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2009

We use seismic ambient noise data recorded by broadband stations around the northern Mississippi Embayment to develop a three‐dimensional shear wave velocity model with full waveform inversion. Empirical Green's functions at periods between 8 and 40s are extracted using a data processing flow based on the continuous wavelet transform. Synthetic waveforms are calculated with an isotropic model through a Graphics Processor Unit‐enabled, collocated finite‐difference code. Starting from the Central United States Velocity Model, the shear wave velocity is iteratively updated with sensitivity kernels constructed using the adjoint method. Several mid‐crustal velocity variations are related to major geological features including the Mississippi Valley graben (MVG), the Ouachita thrust belt, and the Missouri batholith. An intrusion is imaged in northwestern Alabama, coincident with a previously unexplained gravity high. A major change in mid‐crustal velocity occurs across the MVG; much higher velocity crust is present southeast of the graben than northwest. The high velocities are attributed to numerous igneous intrusions, possibly related to formation of the Granite‐Rhyolite province. A strength contrast produced by the change in mid‐crustal velocities may have facilitated formation of the younger, shallower MVG, as external stresses became tensional during Iapetus rifting. The rift pillow is interpreted as the deeper expression of the high velocity crust. Low velocity crust is present below southern Missouri starting at a depth of roughly 20 km. The boundary between the low velocity crust and higher velocity crust to the south and east is sharp and coincides with the Nd‐line. We use seismic waves generated by random noise to investigate the velocity of rocks located down to 25 km in the crust below the central United States. Our velocity model is the first well resolved three‐dimensional velocity model of the mid‐crust and reveals several interesting features. We find low velocities below extended portions of the crust such as the Mississippi Valley graben (MVG) (Reelfoot rift). We find very high velocity crust southeast of the MVG that extends throughout the velocity model. The high velocity crust may have formed more than a billion years ago. Differences in the strength of the crust established by the presence of the high velocity rocks may have influenced the location of the younger MVG and the present‐day location of the New Madrid seismic zone. We also image features in the velocity model that correspond to large positive gravity anomalies and to a major change in basement composition inferred from geochemical data. A three‐dimensional shear wave velocity model for the mid‐crust is developed using full waveform ambient noise tomographyA major change in crustal velocity is observed across the Mississippi Valley graben; higher velocity crust is present to the southeastMid‐crustal velocity variations are related to major geological features and reveal structure related to the growth of the continent A three‐dimensional shear wave velocity model for the mid‐crust is developed using full waveform ambient noise tomography A major change in crustal velocity is observed across the Mississippi Valley graben; higher velocity crust is present to the southeast Mid‐crustal velocity variations are related to major geological features and reveal structure related to the growth of the continent

Native American myopathy (NAM) is an autosomal recessive congenital myopathy first reported in the Lumbee Indian people. Features of NAM include congenital weakness, cleft palate, ptosis, short stature, and susceptibility to malignant hyperthermia provoked by anesthesia.

Abstract: Objective: To determine knowledge of gynecologic cancer risk and screening in women with HNPCC.Study design: Forty-three women with HNPCC were counseled through a gastrointestinal cancer risk program, and later sent a questionnaire regarding their screening practices for gynecologic neoplasms.Results: Twenty-seven (63%) of 43 responded. Fifteen (55%) of 27 had previously been diagnosed with cancer. Among 16 women with a uterus, 11 (69%) reported surveillance by ultrasound or endometrial sampling. Among 21 respondents with ovaries, 13 (62%) reported screening by ultrasound or CA125. Twenty-two (81%) of 27 had seen a gynecologist after receiving their HNPCC diagnosis, but only 12% recalled hearing about risks from their gynecologist, and␣8% from their gynecologic oncologist. Genetic counselors were cited as the most common source (48%) of gynecologic cancer risk information.Conclusions: While the effectiveness of surveillance remains in question, gynecologists can be a source of information regarding gynecologic cancer risk for women from HNPCC families.