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China Institute of Atomic Energy (CIAE) is constructing a high current cyclotron-based boron neutron capture therapy (BNCT) system. The designed proton beam intensity of this cyclotron is 1 mA. The RF system of the cyclotron consists of two separate cavities, two 20-kW amplifiers, a 300-W amplifier for the buncher, and one low-level radio frequency (LLRF) system. The LLRF system controls the amplitudes and phases of the two independent cavities and the buncher. The previous analog–digital hybrid LLRF system in CIAE was designed for low beam loading applications. As during the beam commissioning and machine operation, the RF system requires a more powerful, flexible, and reliable real-time LLRF system, the LLRF group decides to design a new LLRF system for this application. At TRIUMF, a digital LLRF system was developed for the prebuncher of the ARIEL project. This state-of-the-art design is extended and utilized for the BNCT LLRF system. In which, the amplitude and phase of the two separate Dees, as well as the buncher for beam injection, will be regulated by a single field-programmable gate array (FPGA). For such a demanding control task, the design shows a promising future, both from real-time response and flexibility points of view. The design ideas, technology features, system structure, hardware and software development, and the desktop test will be presented.

The Center for Disease Control and Prevention (CDC)'s 2018 Guideline for current practices in pediatric mild traumatic brain injury (mTBI; also referred to as concussion herein) systematically identified the best up-to-date practices based on current evidence and, specifically, identified recommended practices regarding computed tomography (CT), magnetic resonance imaging (MRI), and skull radiograph imaging. In this article, we discuss types of neuroimaging not discussed in the guideline in terms of their safety for pediatric populations, their potential application, and the research investigating the future use of certain modalities to aid in the diagnosis and treatment of mTBI in children. The role of neuroimaging in pediatric mTBI cases should be considered for the potential contribution to children's neural and social development, in addition to the immediate clinical value (as in the case of acute structural findings). Selective use of specific neuroimaging modalities in research has already been shown to detect aspects of diffuse brain injury, disrupted cerebral blood flow, and correlate physiological factors with persistent symptoms, such as fatigue, cognitive decline, headache, and mood changes, following mTBI. However, these advanced neuroimaging modalities are currently limited to the research arena, and any future clinical application of advanced imaging modalities in pediatric mTBI will require robust evidence for each modality's ability to provide measurement of the subtle conditions of brain development, disease, damage, or degeneration, while accounting for variables at both non-injury and time-post-injury epochs. Continued collaboration and communication between researchers and healthcare providers is essential to investigate, develop, and validate the potential of advanced imaging modalities in pediatric mTBI diagnostics and management.

Purpose The neuroimaging correlates of lateralized rhythmic delta activity (LRDA) are not well defined, and imaging findings between different epileptiform patterns have seldom been compared directly. Methods Patients were retrospectively selected from a critical care EEG database between December 2014 and December 2017. Patients were included if they had greater than 6 hours of continuous EEG that contained LRDA, lateralized periodic discharges LPDs), or generalized rhythmic delta activity (GRDA) and had an MRI within 48 hours of the EEG. Clinical, EEG, and MRI characteristics were collected and compared. Results All the following results showed statistical significance between the groups: Patients with GRDA were more likely to have a normal MRI (LRDA, 0%; LPDs, 0.8%; GRDA, 17.3%), although the majority were abnormal. In patients with LRDA and LPDs, the MRI abnormalities were much more likely lateralized to one side, whereas in those with GRDA, they were more likely to have bilateral or multifocal abnormalities. Across all groups most abnormalities were acute, although this proportion was higher in patients with LRDA and LPDs compared with that in those with GRDA (LRDA, 91.3%; LPDs, 86.0%; GRDA, 70.4%). An MRI abnormality that was concordant with the side of LRDA was present in 66.3%, with 17.3% having discordant findings. These were similar in patients with LPDs (concordant 67.4%; discordant 11.6%). Conclusions Patients with LRDA had a similarly high rate of acute focal abnormalities ipsilateral to the EEG pattern compared with those with LPDs. Patients with GRDA were more likely to have a normal MRI, but the majority of patients with GRDA still had acute focal findings.

Status epilepticus (SE) is a collective term that is used to describe a variety of subtypes. Forgetting this point can be perilous, even resulting in exposing patients to unnecessary harms. This review revisits the foundations of many of our current treatment guidelines, providing context to the ever-growing options in the treatment of SE. It aims to highlight the uncertainties that clinicians and EEGers face when treating SE. Several promising future approaches are raised. These bring hope of transitioning to therapies that are based on correcting maladaptive neuronal responses that are personally tailored using real time measures. All types of SE should be diagnosed as soon as possible, and treatment should be started expeditiously. For convulsive SE, treatment should be aggressive with full doses and cessation of seizures should be confirmed with EEG if patients are not returning to normal rapidly. For most other types of SE, the perennial debate about the tortoise or the hare continues: When should we be more measured and conservative and when should we rapidly escalate therapies to a combination of highly sedating agents?

The benchmark tin oxide (SnO2) electron transporting layers (ETLs) have enabled remarkable progress in planar perovskite solar cell (PSCs). However, the energy loss is still a challenge due to the lack of “hidden interface” control. We report a novel ligand-tailored ultrafine SnO2 quantum dots (QDs) via a facile rapid room temperature synthesis. Importantly, the ligand-tailored SnO2 QDs ETL with multi-functional terminal groups in situ refines the buried interfaces with both the perovskite and transparent electrode via enhanced interface binding and perovskite passivation. These novel ETLs induce synergistic effects of physical and chemical interfacial modulation and preferred perovskite crystallization-directing, delivering reduced interface defects, suppressed non-radiative recombination and elongated charge carrier lifetime. Power conversion efficiency (PCE) of 23.02% (0.04 cm2) and 21.6% (0.98 cm2, VOC loss: 0.336 V) have been achieved for the blade-coated PSCs (1.54 eV Eg) with our new ETLs, representing a record for SnO2 based blade-coated PSCs. Moreover, a substantially enhanced PCE (VOC) from 20.4% (1.15 V) to 22.8% (1.24 V, 90 mV higher VOC, 0.04 cm2 device) in the blade-coated 1.61 eV PSCs system, via replacing the benchmark commercial colloidal SnO2 with our new ETLs.

As the COVID-19 pandemic rages unabated, and with more infectious variants, vaccination may offer a way to transit out of strict restrictions on physical human interactions to curb the virus spread and prevent overwhelming the healthcare system. However, vaccine hesitancy threatens to significantly impact our progress towards achieving this. It is thus important to understand the sentiments regarding vaccination for different segments of the population to facilitate the development of effective strategies to persuade these groups. Here, we surveyed the COVID-19 vaccination sentiments among a highly educated group of graduate students from the National University of Singapore (NUS). Graduate students who are citizens of 54 different countries, mainly from Asia, pursue studies in diverse fields, with 32% expressing vaccine hesitancy. Citizenship, religion, country of undergraduate/postgraduate studies, exposure risk and field of study are significantly associated with vaccine sentiments. Students who are Chinese citizens or studied in Chinese Universities prior to joining NUS are more hesitant, while students of Indian descent or studied in India are less hesitant about vaccination. Side effects, safety issues and vaccine choice are the major concerns of the hesitant group. Hence, this study would facilitate the development of strategies that focus on these determinants to enhance vaccine acceptance.

Graded bulk-heterojunction (G-BHJ) with well-defined vertical phase separation has potential to surpass classical BHJ in organic solar cells (OSCs). In this work, an effective G-BHJ strategy via nonhalogenated solvent sequential deposition is demonstrated using nonfullerene acceptor (NFA) OSCs. Spin-coated G-BHJ OSCs deliver an outstanding 17.48% power conversion efficiency (PCE). Depth-profiling X-ray photoelectron spectroscopy (DP-XPS) and angle-dependent grazing incidence X-ray diffraction (GI-XRD) techniques enable the visualization of polymer/NFA composition and crystallinity gradient distributions, which benefit charge transport, and enable outstanding thick OSC PCEs (16.25% for 300 nm, 14.37% for 500 nm), which are among the highest reported. Moreover, the nonhalogenated solvent enabled G-BHJ OSC via open-air blade coating and achieved a record 16.77% PCE. The blade-coated G-BHJ has drastically different D-A crystallization kinetics, which suppresses the excessive aggregation induced unfavorable phase separation in BHJ. All these make G-BHJ a feasible and promising strategy towards highly efficient, eco- and manufacture friendly OSCs., Graded bulk-heterojunction organic solar cell with well-defined vertical phase separation has the potential to surpass the classical counterpart, thus the optimisation of this structure is crucial. Here, the authors reveal solvent selection strategies for optimising morphology of the structure, enabling efficient, eco-friendly, and scalable solar cells.

Objective To determine outcomes of COVID-19 in patients with Multiple Sclerosis (MS) and related conditions, and to determine predictors of these outcomes. Methods This was a multicenter, observational cohort study of patients with MS or related CNS autoimmune disorders who developed confirmed or highly suspected COVID-19 infection from 2/1/2020 to 12/31/2020. Main Outcome and Measure The primary outcome measure was hospitalization status due to COVID-19. Severity of infection was measured using a 4-point ordinal scale: 1. home care; 2. hospitalization without mechanical ventilation; 3. hospitalization and mechanical ventilation, and 4. death. Results Of 474 patients in the study, 63.3% had confirmed COVID-19 infection and 93.9% were diagnosed with an MS phenotype. Mean age was 45±13 (mean±SD) years, 72% were female, and 86% were treated with a DMT at the time of infection. 58 patients (12.2%) were hospitalized. 24 patients (5.1%) were critically ill (requiring ICU care or outcome of death), of which 15 patients (3.2%) died. Higher neurological disability and older age independently predicted hospitalization. 85% (102/120) of patients with known antibody results not treated with anti-CD20 therapies were seropositive while only 39.5% (17/43) of patients treated with anti-CD20 demonstrated seropositivity (p

Aim A large proportion of young people with chronic health conditions are surviving into adulthood. They face the same challenges as their healthy peers and are at increased risk of mental health problems. Psychosocial assessment is a crucial aspect of clinical care. Interviews using the internationally used and accepted HEEADSSS (home environment, education/employment, eating, peer-related activities, drugs, sexuality, suicide/depression, and safety) framework require trained clinicians, rapid interpersonal engagement, time and manual documentation. HEEADSSS-derived digital self-report surveys can be initiated by non-trained staff. This study compares the utility and information recorded using both methods. Methods A retrospective analysis comparing documentation from HEEADSSS guided face-to-face interview and a digital survey tool was conducted using 146 records collected by the Trapeze transition service across the two locations of the Sydney Children's Hospital Network (NSW, Australia) between 2013 and 2016. A panel of four experts used an iterative process to identify 29 data verification points, falling into seven categories. Wilcoxon signed-rank tests were used to compare category scores. Results The digital survey took an average of 15 min and showed a significantly higher rate of disclosure across all psychosocial categories, particularly in the sensitive areas of emotions, drug use, sex and safety, compared to electronic medical record documentation of interview. Conclusions Digital survey provided a time-efficient psychosocial screening tool that was self-administered, able to be introduced by non-trained staff, had a consistent record of responses, and elicited a substantially higher disclosure rate for important areas of strength and risk that may otherwise be avoided or not recorded.

Single junction organic photovoltaic devices (OPVs) have exceeded 15% power conversion efficiency (PCE) with the help of fused ring based low-bandgap non-fullerene acceptors (NFAs). As a major type of NFA, the indacenodithiophene derivative NFA (IDTBR) has been shown to have superior OPV stability with outstanding V OC , but the efficiency is relatively lower compared to the reported OPV champion devices. Further improvements towards high efficiencies in this OPV system remains challenging due to the relatively poor charge carrier transport properties in the bulk heterojunction film, particularly the electron transport in small molecule non-fullerene acceptor network. Here we conducted detailed study on the dependence of carrier transport on BHJ donor–acceptor (D–A) composition. Our results show that the nano-morphology or phase aggregation of non-fullerene acceptor (NFA) molecules can be tuned via D–A composition in bulk heterojunction layer, and the improvement of electron mobility was shown to be enhanced by almost one order – from 1.23 × 10 −6 cm2/V (D:A = 1:1 by weight) to 1.02 × 10−5 cm2 /V (D:A = 1:2) – due to the improved connectivity of electron transport pathways. Further increase of NFA component content, however, has led to over-sized phase segregation, deteriorating the photovoltaic performance of organic soar cells. The optimized BHJ cell shows more balanced charge carrier transport and phase segregation, which yields a PCE of 10.79%. Furthermore, it shows a V OC as high as 1.03 V, which is ascribed to the significantly suppressed radiative and non-radiative recombination losses with bandgap-VOC offset Eg/q-VOC of only 0.55 V.

Two regioisomeric wide-bandgap (WBG) polymers, PDBT(E)BTz-p and PDBT(E)BTz-d, with different nitrogen topologies along the conjugated backbone were developed and applied in non-fullerene polymer solar cells. Both polymers exhibit deeper ionization potential (IP) enabled by the synergistic electron-withdrawing effect of chlorine atoms and ester substituents. The effects of different nitrogen topologies on polymeric backbone linearity and optoelectronic and photovoltaic properties are systematically investigated. When blended with the electron acceptor IT-4F, the PDBT(E)BTz-p-based device delivers a PCE of 6.96% with a high VOC of 0.98 V and a low energy loss of 0.55 eV, while the PDBT(E)BTz-d-based device exhibits a higher PCE of 7.81% with an improved FF. Furthermore, PDBT(E)BTz-d is found to be effective as the third component in a binary PBDB-T-SF:IT-4F system to enhance device efficiencies from 12.1% for the binary device to 13.4% for the ternary device with 5 wt% PDBT(E)BTz-d relative to PBDB-T-SF. It is observed that an internal Forster resonance energy transfer (FRET) between PDBT(E)BTz-d and PBDB-T-SF gives rise to the improvement of external quantum efficiency and JSC. These results demonstrate that the WBG polymer featuring deeper IP can not only enhance the VOC but can also act as a sensitizer to transfer energy through the FRET mechanism toward highly efficient ternary PSCs. In addition, this contribution provides a new idea for the design and synthesis of conjugated polymers for organic electronics.

Introduction: Malaria is a vector-borne disease caused by Plasmodium group and it’s transmitted to humans via bites from the infected female Anopheles mosquitoes The disease burden of malaria is staggering particularly in Sub-Saharan Africa followed by South-East Asia Initial manifestations of malaria include fever and flu-like symptoms Severe malaria is characterized by the presence of hyperparasitemia, metabolic acidosis, severe anemia, hypoglycemia and organs involvement (cerebral and renal) Traditionally, we had hypothesized that the sequestered parasitized erythrocytes in the micro-circulation causing tissue hypoxia underlying severe malaria Nevertheless, more evidence has arisen to suggest that hypercytokinemia might contribute to mitochondrial dysfunction leading to tissue hypoxia Methods: Herein we would like to report a case of using continuous veno-venous haemofiltration (CVVH) with haemoperfusion in a patient with severe malaria with multi-organ involvement Results: A 59 year-old man who was active in off-roading presented to our hospital with the complaint of fever and shortness of breath for a week He had an off-road drive in the jungle 2 weeks prior to the presentation and denied any rodent contact He was febrile and tachypneic with hypoxia and was intubated in view of persistent type 1 respiratory failure He required inotropic support and was referred to the nephrology unit for oliguric acute kidney injury He was negative for covid-19 and leptospirosis but blood film showed Plasmodium Knowlesi infection with high parasite density (158,000 p/ul of blood) He was loaded with intravenous artesunate and oral doxycycline Haemoperfusion was initiated along with CVVH (oXiris filter with replacement fluids of 25mls/kg/hour in pre:post filter ratio of 70:30) in view of severe malaria with kidney involvement After 1 day of therapy, his SOFA score and blood parameters improved and he was extubated subsequently He recovered well with antimalarial agents and he required intermittent haemodialysis for almost 1 month after discharge Nevertheless, he developed chronic kidney disease (stage 3a with eGFR 50 5) and was monitored in the nephrology clinic 3 monthly [Formula presented] [Formula presented] Conclusions: The prognosis in severe malaria is grave when there is multi-organ involvement Timely administration of antimalarial agents are crucial in the management of severe malaria Haemoperfusion might be helpful in the case of severe malaria with cytokines dysregulation We were able to wean off the inotropic and ventilatory support rapidly in conjunction with the decreasing levels of cytokines Regrettably, patient progressed to CKD and we attributed it to the acute tubular necrosis secondary to septic shock No conflict of interest

Purpose of ReviewNeurologic complications are increasingly recognized in the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This coronavirus is related to severe acute respiratory syndrome coronavirus (SARS-CoV) and other human coronavirus-related illnesses that are associated with neurologic symptoms. These symptoms raise the question of a neuroinvasive potential of SARS-CoV-2.Recent FindingsPotential neurologic symptoms and syndromes of SARS-CoV-2 include headache, fatigue, dizziness, anosmia, ageusia, anorexia, myalgias, meningoencephalitis, hemorrhage, altered consciousness, Guillain-Barré syndrome, syncope, seizure, and stroke. In addition, we discuss neurologic effects of other coronaviruses, special considerations for management of neurologic patients, and possible long-term neurologic and public health sequelae.SummaryAs SARS-CoV-2 is projected to infect a large part of the world's population, understanding the potential neurologic implications of COVID-19 will help neurologists and others recognize and intervene in neurologic morbidity during and after the pandemic of 2020.

Epitaxial growth gives the highest-quality crystalline semiconductor thin films for optoelectronic devices. Here, a universal solution-processed bottom-up quasi-epitaxial growth of highly oriented α-formamidinium lead triiodide (α-FAPbI3 ) perovskite film via a two-step method is reported, in which the crystal orientation of α-FAPbI3 film is precisely controlled through the synergetic effect of methylammonium chloride and the large-organic cation butylammonium bromide. In situ GIWAXS visualizes the BA-related intermediate phase formation at the bottom of film, which serves as a guiding template for the bottom-up quasi-epitaxial growth in the subsequent annealing process. The template-guided epitaxially grown BAFAMA perovskite film exhibits increased crystallinity, preferred crystallographic orientation, and reduced defects. Moreover, the BAFAMA perovskite solar cells demonstrate decent stability, maintaining 95% of their initial power conversion efficiency after 2600 h ambient storage, and 4-time operation condition lifetime enhancement.

The combination of a bulk 3D perovskite layer and a reduced dimensional perovskite layer (perovskite quantum wells (PQWs)) is demonstrated to enhance the performance of perovskite solar cells (PSCs) significantly in terms of stability and efficiency. This perovskite hierarchy has attracted intensive research interest; however, the in-depth formation mechanism of perovskite quantum wells on top of a 3D perovskite layer is not clearly understood and is therefore the focus of this study. Along with ex situ morphology and photophysical characterization, the time-resolved grazing-incidence wide-angle X-ray scattering (TS-GIWAXS) technique performed in this study provides real-time insights on the phase-transition during the organic cation (HTAB ligand molecule) coating and PQWs/3D architecture formation process. A strikingly strong ionic reaction between the 3D perovskite and the long-chain organic cation leads to the quick formation of an ordered intermediate phase within only a few seconds. The optimal PQWs/3D architecture is achieved by controlling the HTAB casting, which is assisted by time-of-flight SIMS characterization. By controlling the second ionic reaction during the long-chain cation coating process, along with the fluorinated poly(triarylamine) (PTAA) as a hole-transport layer, the perovskite solar cells demonstrate efficiencies exceeding 22% along with drastically improved device stability.

We present a 1.6Tbps coherent transceiver delivering 800Gbps/wave transmission using integrated Tx/Rx functions with 50GHz bandwidth and 50kHz linewidth tunable lasers on a single 2-channel InP PIC, paired with a SiGe Driver and TIA ASIC.

Jaw pain after dental and orthodontic procedures presents commonly in primary care and osteopathic manipulative medicine (OMM) clinics. Osteopathic cranial manipulative medicine (OCMM) treatment of the jaw and head can both provide pain relief and improve temporomandibular joint function after dental procedures. In this case report, a 47-year-old woman with severe jaw pain had worsening pain after a repeated root canal procedure and was unable to chew solid foods. She was scheduled for another root canal for the affected tooth but after serial cranial osteopathic treatments, she was to avoid a third procedure due to periodontal tissue improvement. To the author’s knowledge, this is the first case report involving the use of osteopathic manipulative treatment (OMT) for jaw pain following root canal procedures.

Background Seminal trials evaluating anti-CD20 therapy in progressive MS primarily found benefit in younger, less-disabled patients with more inflammatory disease activity. The risks and benefits of ocrelizumab use in older patients with progressive froms of MS are not known. Methods Retrospective chart review was performed for patients older than 55 with primary or secondary progressive MS at the time of ocrelizumab initiation. Clinical endpoints from 2 years prior to anti-CD20 therapy served as a within-subject control. Results Data was reviewed for 56 patients older than the age of 55 at the time of ocrelizumab initiation. Of 37 patients with 2-years of follow up on ocrelizumab, 40%(n=15) experienced confirmed disability progression (CDP) while 60% (n=22) remained stable or improved. 24 patients had data available for the within-subject control; for these patients, median age was 67, baseline EDSS 6.3, and disease duration 20.5 years. Prior to anti-CD20 therapy, 58% (n=14) of patients remained stable and 42% (n=10) experienced CDP. After ocrelizumab initiation, 71% (n=17) remained stable and 29% (n=7) experienced CDP. There was no difference between CDP (p=0.54) or change in EDSS (p=0.09) between time periods. Ocrelizumab was well tolerated and no difference in infection rate was seen using the within-subject control. Conclusions We found no difference in clinical endpoints for patients on ocrelizumab compared to prior to anti-CD20 therapy; however, we could not exclude a modest effect given our sample size. Larger trials are needed to evaluate ocrelizumab use in this understudied MS subpopulation.

Objective Misuse of child restraint systems is a widespread and long-standing problem impacting risk of injury and death in car crashes. Discomfort has been suggested as a causative factor for misuse, particularly in errors introduced by children while they use the restraints. However, the relationship between comfort and errors in use has never been studied. In this study we examine the reliability and sensitivity of a newly developed observational method for assessing comfort in children in vehicles. We then use this method to examine the relationship between comfort and errors in use of booster seats. Methods A novel method was developed for assessing comfort by counting fidgeting and postural adjustment behaviors to derive a Discomfort Avoidance Behavior (DAB) score. The sensitivity of the DAB score was examined by observing children in four different seating conditions designed as “comfortable” and “uncomfortable” (Part 1). Paired-samples t-tests were used to compare differences in DAB between seating conditions. The reliability of the DAB score was assessed by calculating the intraclass correlation coefficient (ICC) between DAB scores recorded by different researchers. The association between comfort and correctness of use was examined by observing children using booster seats (Part 2). The association between DAB score and number of usage errors was tested using linear regression analysis. Participants were children ages 4–8 years. Fourteen children participated in Part 1 and 15 children in Part 2. Results The DAB score was sensitive to changes in seat condition (p < 0.01), and was repeatable between different researchers (ICC 0.98, 95% confidence interval [CI] 0.954–0.991). Increases in DAB were associated with increases in the number of use errors among children using booster seats (errors in use = 3.89 × DAB − 2.18, p < 0.0001). Conclusion The DAB score is a reliable and valid measure of comfort of children in child restraints but could be improved by incorporating a measurement of postural positioning. Comfort, as characterized by fidgeting and postural adjustment behaviors, is associated with correct use of child restraints. The broader implication is that this confirms ergonomic design of child restraints as important for minimizing errors in use. There is a need for further study of the impact of specific restraint design features on comfort experienced by children.

The performance of perovskite solar cells (PSCs) are determined by a number of factors including the quality of perovskite absorber, types of the carrier transports layers and the interfacial quality between the perovskite thin film and carrier transport layers. This work demonstrates effective fabrication strategies focusing on the mixed perovskites and electron transport layers (ETLs). A novel cryogenic-assisted technique is used to grow high-quality mixed perovskite thin films. The performance of PSCs based on SnO 2 ETL is found to be more promising compared to the commonly used TiO 2 , in terms of power conversion efficiency (PCE) and light stability. To achieve hysteresis-free PSCs, the architecture of the electron transport layers should be also carefully optimized.

Aims The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level. Patients and Methods This was a retrospective study of 235 consecutive patients who had undergone decompression-only surgery for lumbar spinal stenosis and had a minimum five-year follow-up. There were 106 female patients (45.1%) and 129 male patients (54.9%), with a mean age at surgery of 66.8 years (sd 11.3). We excluded those with adult deformity and spondylolisthesis. Presenting symptoms, levels operated on initially and at re-operation were studied. MRI measurements included the anteroposterior diameter of the bony spinal canal, the degree of disc degeneration, and the thickness of the ligamentum flavum. DSS was defined by comparative measurements of the bony spinal canal. Risk factors for re-operation at the adjacent level were determined and included in a multivariate stepwise logistic regression for prediction modelling. Odds ratios (ORs) with 95% confidence intervals were calculated. Results Of the 235 patients, 21.7% required re-operation at an adjacent segment. Re-operation at an adjacent segment was associated with DSS (p = 0.026), the number of levels decompressed (p = 0.008), and age at surgery (p = 0.013). Multivariate regression model (p < 0.001) controlled for other confounders showed that DSS was a significant predictor of re-operation at an adjacent segment, with an adjusted OR of 3.93. Conclusion Patients with DSS who have undergone lumbar spinal decompression are 3.9 times more likely to undergo future surgery at an adjacent level. This is a poor prognostic indicator that can be identified prior to index decompression surgery.

Ureteral stent (UrSt) placement has been shown to be a significant independent risk factor for BK viruria, viremia and BK virus nephropathy. We assessed if this observation could be validated at our high volume kidney transplant center that has had a strong historical focus on BK virus nephropathy detection. We performed a retrospective case-control study of adults receiving a kidney-only transplant and followed for one year between 2004 and 2011 with uniform immunosuppression and use of blood BK virus PCR screening protocol. Among 1147 patients, 443 (38.6%) received a UrSt, and 17.2% with a UrSt had BK viremia versus 13.5% without stent (odds ratio 1.33; 95% CI 1.00-1.78). We confirmed a previously reported association between immediate graft function (IGF) and higher rate of BK viremia (15.7% versus 5.9% in patients without IGF). On multivariable competing risks Cox regression in patients with IGF, UrSt (adjusted hazard ratio [aHR] 1.35;95% CI 1.04-1.75) and African-American race (aHR 1.47;95% CI 1.04-2.09) significantly increased the risk for BK viremia. In the largest sample size to date, we confirmed that UrSt placement during kidney transplant surgery is a risk factor for BK viremia within the first year post-transplant and that IGF is associated with BK viremia. This article is protected by copyright. All rights reserved.

TRIUMF’s ARIEL pre-buncher is powered by a sawtooth waveform which is the combination of 11.79 MHz, 23.57 MHz and 35.36 MHz harmonics. To upgrade the existing analog and digital hybrid LLRF control system, reduce the hardware cost, and achieve more flexible control of the system, an FPGA based digital daughter board is designed. The generation, control, and regulation of these three harmonics are all incorporated digitally inside a single FPGA. To reduce the number of RF interfaces on the motherboard, the new daughter board is designed to control the amplitude and phase of the sawtooth waveform with one channel ADC and DAC. To lock the output phase of the sawtooth waveform to the reference signal, a digital phase-locked loop is designed to lock all three harmonics to the external reference signal. The related work, including the system design of the LLRF control system and the development of the digital phase-locked loop, are presented in this paper.

Background: Transcranial direct-current stimulation (tDCS) facilitates cognitive improvement in healthy and pathological populations. It has been increasingly used in cases of mild cognitive impairment (MCI) and dementia. Our research question is: Can tDCS serve as a clinical intervention for improving the cognitive functions of persons with MCI (PwMCI) and dementia (PwD)? Objective: This systematic review evaluated the evidence to determine the efficacy of tDCS in improving cognitive outcomes in PwD and PwMCI. Methods: A systematic review was conducted of studies published up to November 2017 involving tDCS in cases of MCI and dementia. Studies were ranked according to the level of evidence (Oxford Center for Evidence-Based Medicine) and assessed for methodological quality (Risk of Bias Tool in the Cochrane Handbook for Systematic Reviews of Interventions). Data was extracted on all protocol variables to establish a reference framework for clinical interventions. Different modalities, tDCS alone or combined with cognitive training, compared with sham tDCS were examined in both short and long-term effects. Four randomized control trials (RCTs) with memory outcomes were pooled using the fixed-effect model for the meta-analysis. Results: Twelve studies with 195 PwD and four with 53 PwMCI met the inclusion criteria. Eleven articles were ranked as Level 1b. The results on the meta-analysis on pooled effects of memory indicated a statistically significant medium effect size of 0.39 (p = 0.04) for immediate effects. This improvement was not maintained in the long term 0.15 (p = 0.44). Conclusion: tDCS improves memory in PwD in the short term, it also seems to have a mild positive effect on memory and language in PwMCI. However, there is no conclusive advantage in coupling tDCS with cognitive training. More rigorous evidence is needed to establish whether tDCS can serve as an evidence-based intervention for both populations.

Background Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus. Methods and Results A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments. Conclusions Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Mass gathering events that involve special populations have challenges that require unique medical planning. The key to a successful mass event is in the preparation, planning, and communication. Concerns in communication such as language barriers, age of participants, and intellectual disability should be addressed early in the planning. In the event of a mass casualty disaster, there should be a clear chain of command and escalation policy. The primary concern of the sports medicine team is to ensure safety for the participation of an athlete. The risk of injury to an athlete varies depending on the event and venue. The sporting venue may require special consideration for access to athletes, crowd control, and ingress/egress of medical personnel and transports. In order to ensure safety and efficient care, it is paramount to have the necessary medical planning and preparedness to manage a large-scale sporting event.

Policies and guidelines regarding sale of ready-to-eat raw fish dishes have been updated., We assessed microbial safety and quality of raw fish sold in Singapore during 2015–2016 to complement epidemiologic findings for an outbreak of infection with group B Streptococcus serotype III sequence type (ST) 283 associated with raw fish consumption. Fish-associated group B Streptococcus ST283 strains included strains nearly identical (0–2 single-nucleotide polymorphisms) with the human outbreak strain, as well as strains in another distinct ST283 clade (57–71 single-nucleotide polymorphisms). Our investigations highlight the risk for contamination of freshwater fish (which are handled and distributed separately from saltwater fish sold as sashimi) and the need for improved hygienic handling of all fish for raw consumption. These results have led to updated policy and guidelines regarding the sale of ready-to-eat raw fish dishes in Singapore.

In this paper we report the growth of high quality SnS thin films with good crystallinity deposited on two-dimensional (2D) mica substrates. It is believed that the 2D nature of SnS, with strong intra-layer covalent bonds and weak inter-layer van der Waals interactions, is responsible for its relative insensitivity to lattice mismatch. We also investigated the reduction of Sn vacancies in the material using Sn-compensation technique during the material growth process. The experimental results clearly demonstrated substantial enhancements in the electrical and structural properties for films deposited using Sn-compensation technique. A mobility of 51 cm2 V−1 s−1 and an XRD rocking curve full width at half maximum of 0.07° were obtained. Sn-compensated SnS/GaN:Si heterojunctions were fabricated and significant improvement in both the I-V characteristics and the spectral responsivities of the devices were characterized.

BACKGROUND AND PURPOSE Fractional flow may identify hemodynamic effects and ischemic risk beyond percent stenosis of an artery. We hypothesized that diminished TOF-MRA signal intensity distal to an intracranial stenosis predicts stroke risk. METHODS TOF-MRA was acquired prospectively in the SONIA-WASID trials. The distal/proximal signal intensity ratio (SIR) was calculated from 3 mm regions of interest, blinded to outcome. Univariate and multivariate analyses included clinical variables, SIR, and invasive angiography measures to identify predictors for risk of stroke in the territory. RESULTS 189 patients with 50-99% symptomatic intracranial stenosis in SONIA-WASID had TOF-MRA available. In univariate analysis, the hazard ratio (HR) for stroke in the territory of the symptomatic artery with SIR < .9 was 5.2 (1.8, 15.3; P < .001) as compared to SIR ≥ .9. Multivariate analysis correcting for baseline systolic blood pressure, LDL, centrally measured percent stenosis, recency of symptoms, TICI and downstream collaterals, the HR for SIR < .9 was 10.9 (2.0, 58.9; P < .001). In those with

Polymer solar cells (PSCs) have seen great progress in recent years, with power conversion efficiencies of over 15%. However, PSCs suffer from larger energy losses than inorganic and perovskite solar cells, leading to lower open-circuit voltage ( V OC). The main factors that hinder the V OC improvements include (i) relatively large nonradiative recombination losses and thus low electroluminescence quantum efficiency (EQEEL) in PSCs and (ii) the existence of a charge transfer state at the interface of donor and acceptor. For efficient charge separation in state-of-the-art PSCs, empirically, the driving force for exciton dissociation is considered to be at least 0.3 eV. The large driving force could lead to large voltage losses and thus hinder the PSC performance. In this study, we report using wide bandgap material PB3T as electron donor and low bandgap material IEICO-4F as electron acceptor for nonfullerene PSCs with very small driving forces, which, however, show a decent maximum external quantum efficiency (EQE) of nearly 40%. Moreover, we demonstrate a nonfullerene PSC with high EQEEL up to 5.1 × 10 − 4, corresponding to very low nonradiative recombination losses of 0.20 eV and overall photovoltage energy losses of 0.46 to 0.52 eV, derived from different bandgap ( E gap) determination methods, which can now be comparable to those in perovskite solar cells and inorganic solar cells.

This paper proposed a RF-based mapping-based indoor localization technique to locate their packages and items. The Received Signal Strength Indicator (RSSI) is commonly used in trilateration to allocate the packages or items location. However, several problems need to overcome to increase the accuracy of the RSSI signal propagation for the localization. The problems include the complexity of the indoor environment will affect the radio waves experienced multipath effect such as the signal may be reflected, refracted, absorbed or blocked by other matter. The paper is designed to study the propagation of radio waves in indoor conditions, identify the type of antenna used and determine the accuracy of the localization model. The RSSI is recorded for every 1m until reached the maximum read range of 20m to study the behaviour of radio waves propagation and the relationships between RSSI and distance. The RSSI mapping experiment was carried out to determine the type of antenna used to carry out the experiment. The localization is performed with mapping-based technique to predict the random coordinates in the testbed. The predicted coordinates and actual coordinates were compared to determine the accuracy of the localization model. The error between the actual coordinates and predicted coordinates can achieve an average of 0.95 meter. The RF mapping-based indoor localization technique results shown that the effectiveness of the techniques to be implemented in a company to improve the efficiency in the production line.

Background Potential pain with IUD insertion is a concern for women. Studies have found that systemic and local cervical therapies do not reduce pain scores. Since intrauterine infusion of lidocaine may reduce pain with endometrial aspiration, in this pilot study, we tested whether such infusion through an inexpensive endometrial aspirator could reduce IUD insertion pain scores with IUD insertion. Study Design In this randomized, double-blinded, placebo control pilot study of 40 women undergoing IUD insertion, pain scores of women receiving 1.2 mL 2% lidocaine versus normal saline (1:1) infused 3 min prior to IUD insertion were measured using a 0–9-point scale. Results Pain at tenaculum placement was similar between groups. There was no difference in mean pain scores during IUD insertion of women infused with lidocaine (2.95) versus normal saline (3.75), p=.37. Considerable variation in pain scores was noted; 46% of subjects had pain scores ≤ 2 while 33% had pain scores ≥ 5. Conclusion Use of 2% lidocaine administered through an endometrial aspirator did not significantly reduce IUD insertion pain scores in this pilot study.

Light-emitting diodes (LEDs) based on p-GaN/ZnO heterojunction were fabricated. ZnO thin film deposited by electron-beam deposition and ZnO nanorods grown by electrodeposition were used as n-type materials. Devices with and without ~ 10 nm thick MgO interlayer between p-GaN and ZnO were prepared. The existence of MgO interlayer significantly affected LED performance compared to LEDs without MgO interlayer. In the photoluminescence measurements, p-GaN/MgO/ZnO nanorods exhibited stimulated emission under pulsed optical excitation, while no stimulated emission was observed in the absence of MgO. The effect of MgO interlayer on ZnO growth, optical and electrical properties, as well as the emission spectra of LEDs is discussed in detail.

High quality wafer-scale free-standing WS2 grown by van der Waals rheotaxy (vdWR) using Ni as a texture promoting layer is reported. The microstructure of vdWR grown WS2 was significantly modified from mixture of crystallites with their c-axes both parallel to (type I) and perpendicular to (type II) the substrate to large type II crystallites. Wafer-scale transfer of vdWR grown WS2 onto different substrates by an etching-free technique was demonstrated for the first time that utilized the hydrophobic property of WS2 and hydrophilic property of sapphire. Our results show that vdWR is a reliable technique to obtain type-II textured crystallites in WS2, which is the key factor for the wafer-scale etching-free transfer. The transferred films were found to be free of observable wrinkles, cracks, or polymer residues. High quality p-n junctions fabricated by room-temperature transfer of the p-type WS2 onto an n-type GaN was demonstrated with a small leakage current density of 29.6 μA/cm2 at −1 V which shows superior performances compared to the directly grown WS2/GaN heterojunctions.

AIM: Good seat belt fit and positioning is important for crash protection. Older drivers experience problems in achieving good seat belt fit and often reposition seat belts and/or use seat cushions. Comfort influences these behaviours. This work examines the impact of functional morbidities on belt positioning and accessory use and whether comfort mediates this relationship METHODS: Mediation analysis was used to examine the relationship between morbidities affecting physical function, comfort, belt repositions and seat cushion use among 380 drivers aged 75 years and older. RESULTS: Musculoskeletal morbidities increase the likelihood of seat belt repositioning (OR 1.37, 95% CI 1.12-1.67) and comfort partially mediates this relationship (P = 0.03). Morbidities of any type also increase the likelihood of seat cushion use (OR 1.15 95% CI 1.04-1.27), but comfort plays no role in this relationship (P = 0.87). CONCLUSION: Greater awareness among older drivers is needed, to ensure behavioural modifications do not impair their crash protection.© 2016 AJA Inc. Language: en

Suboptimal child restraint use includes incorrect and/or inappropriate restraint use and increases the risk of injury. Comfort has been suggested as an important factor impacting on optimal use of restraints by children. This article aims to examine the relationships between parent reported comfort and restraint misuse and age-appropriate restraint choice.This is an analysis of data from a cross sectional observation study of child restraint use in New South Wales. Logistic regression was used to model the relationship between parent-reported comfort and restraint misuse and age-appropriate restraint choice.There was no significant relationship between either parent-reported comfort and restraint misuse or parent-reported comfort and age-appropriate restraint choice.Parent perceptions of comfort of children in child restraints do not appear to be associated with incorrect child restraint use or age appropriate restraint choice. It is possible that the actual comfort of the child may be related to incorrect use but this remains to be tested. Further investigation of the relationship between parent-perceived comfort and the actual comfort of the child, as well as the impact of child comfort on optimal child restraint use is warranted.

Purpose Advanced neuroimaging techniques may improve patient selection for endovascular stroke treatment but may also delay time to reperfusion. We studied the effect of advanced modality imaging with CT perfusion (CTP) or MRI compared with non-contrast CT (NCT) in a multicenter cohort. Materials and methods This is a retrospective study of 10 stroke centers who select patients for endovascular treatment using institutional protocols. Approval was obtained from each institution9s review board as only de-identified information was used. We collected demographic and radiographic data, selected time intervals, and outcome data. ANOVA was used to compare the groups (NCT vs CTP vs MRI). Binary logistic regression analysis was performed to determine factors associated with a good clinical outcome. Results 556 patients were analyzed. Mean age was 66±15 years and median National Institutes of Health Stroke Scale score was 18 (IQR 14–22). NCT was used in 286 (51%) patients, CTP in 190 (34%) patients, and MRI in 80 (14%) patients. NCT patients had significantly lower median times to groin puncture (61 min, IQR (40–117)) compared with CTP (114 min, IQR (81–152)) or MRI (124 min, IQR (87–165)). There were no differences in clinical outcomes, hemorrhage rates, or final infarct volumes among the groups. Conclusions The current retrospective study shows that multimodal imaging may be associated with delays in treatment without reducing hemorrhage rates or improving clinical outcomes. This exploratory analysis suggests that prospective randomised studies are warranted to support the hypothesis that advanced modality imaging is superior to NCT in improving clinical outcomes.

Fabricated on nanoscale epitaxial lateral overgrown (NELO) GaN layers (type N) by metal-organic chemical vapor deposition using a SiO 2 layer with nanometer scale windows as the growth mask. Transmission electron microscopy (TEM) results clearly demonstrate coherent growth of GaN in the window regions while lateral growth is observed over the SiO 2 layer. Based on the TEM and atomic force microscopy measurements, we observed substantial reduction in the threading dislocation density for the type N GaN films. Experimental results on electroluminescence (EL) measurement indicate substantial improvement in the EL intensity as well as a 15 nm blue shift in the EL peak wavelength. High resolution X-ray diffraction and reciprocal space mapping characterizations clearly indicate significant reduction in strain generation in the MQWs grown on NELO GaN layers compared to the control samples (type C). Such reduction in strain generation in the MQW gives rise to the reduction in the quantum-confined Stark effect. This is also consistent with the observed blue-shift in the EL peak. Detailed analyses of the optoelectronic properties of the devices indicate significant improvements in the internal quantum efficiency, η i , and the extraction efficiency, η e , by as much as 55.8 and 57.3%, respectively, compared to the type C devices. The improvement in η i is attributed to reductions in both the nonradiative recombination centers and the quantum-confined Stark effect in the type N devices and the improvement in the extraction efficiency is attributed to the texturing of the GaN layer due to the incorporation of the SiO 2 layer with nanometer scale windows.

The LCLS hard X-ray Free Electron Laser at SLAC reported first lasing in April 2009. Since then two successful user runs have been completed at the two soft X-ray stations. The first hard X-ray station has started commissioning in July 2010. Beam diagnostics play an essential role for tuning the machine and delivering the requested beam properties to the users. An overview of the LCLS photon diagnostics will be presented including some selected commissioning results. Plans for future improvements and upgrades will be briefly discussed.

ZnO nanorods were fabricated by electrodeposition from solution with and without thulium precursors and characterized by scanning electron microscopy, energy dispersive X-ray spectroscopy, X-ray diffraction, photoluminescence and time-resolved photoluminescence. In spite of the low incorporation of thulium into ZnO nanorods, both the morphology and the optical properties of the nanorods were affected by the presence of thulium. The light emitting diodes with ZnO nanorods with and without Tm have been demonstrated.

SCOPUS: ar.j, info:eu-repo/semantics/published