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Stakeholder engagement is increasingly integrated into clinical research processes. We conducted a mixed methods analysis to describe stakeholders' (peer ostomates, ostomy nurses, telehealth engineers) perceptions of their engagement and participation in a multisite, randomized trial of a telehealth-delivered curriculum for cancer survivors with ostomies.Stakeholder notes were analyzed using narrative analysis. We constructed a 15-item survey that assessed the following areas: adherence to stakeholder engagement principles, engagement/influence throughout the study process, impact on perceived well-being, and satisfaction. Stakeholders were invited to complete the survey anonymously. Quantitative survey data were tabulated through summary statistics.Across intervention sessions, an average of 7.7 ± 1.4 stakeholders attended and 2.6 ± 1.4 submitted a note per session. The survey response rate was 73% (11/15). Stakeholders reported high agreement that the study adhered to engagement principles (91% reciprocal relationships, 100% co-learning, partnership, and transparency/honesty/trust). They felt highly engaged (18% moderate, 73% great deal) and that they had influence on study initiation (27% moderate, 55% great deal), intervention delivery (9% moderate, 82% great deal), fidelity assessment (18% moderate, 73% great deal), analysis and interpretation (55% moderate, 27% great deal), and dissemination (45% moderate, 45% great deal). They reported high overall satisfaction with roles (91% great deal), believed the program was helpful for participants (91%), and that serving on study team benefited their own well-being (100%).Our strategy of stakeholder inclusion led to high engagement, input, satisfaction, and belief in success of program, which could be mirrored in other trials.

OBJECTIVECerebral vasospasm (CV) is a delayed, sustained contraction of the cerebral arteries that tends to occur 3–14 days after aneurysmal subarachnoid hemorrhage (aSAH) from a ruptured aneurysm. Vasospasm potentially leads to delayed cerebral ischemia, and despite medical treatment, 1 of 3 patients suffer a persistent neurological deficit. Bedside transcranial Doppler (TCD) ultrasonography is used to indirectly detect CV through recognition of an increase in cerebral blood flow velocity (CBFV). The present study aimed to use TCD ultrasonography to monitor how CBFV changes on both the ipsi- and contralateral sides of the brain in the first 24 hours after patients have received a stellate ganglion block (SGB) to treat CV that persists despite maximum standard therapy.METHODSThe data were culled from records of patients treated between 2013 and 2017. Patients were included if an SGB was administered following aSAH, whose CBFV was ≥ 120 cm/sec and who had either a focal neurological deficit or reduced consciousness despite having received medical treatment and blood pressure management. The SGB was performed on the side where the highest CBFV had been recorded with 8–10 ml ropivacaine 0.2%. The patient’s CBFV was reassessed after 2 and 24 hours.RESULTSThirty-seven patients (male/female ratio 18:19), age 17–70 years (mean age 49.9 ± 11.1), who harbored 13 clipped and 22 coiled aneurysms (1 patient received both a coil and a clip, and 3 patients had 3 untreated aneurysms) had at least one SGB. Patients received up to 4 SGBs, and thus the study comprised a total of 76 SGBs.After the first SGB, CBFV decreased in 80.5% of patients after 2 hours, from a mean of 160.3 ± 28.2 cm/sec to 127.5 ± 34.3 cm/sec (p < 0.001), and it further decreased in 63.4% after 24 hours to 137.2 ± 38.2 cm/sec (p = 0.007). A similar significant effect was found for the subsequent SGB. Adding clonidine showed no significant effect on either the onset or the duration of the SGB. Contralateral middle cerebral artery (MCA) blood flow was not reduced by the SGB.CONCLUSIONSTo the authors’ knowledge, this is the largest study on the effects of administering an SGB to aSAH patients after aneurysm rupture. The data showed a significant reduction in ipsilateral CBFV (MCA 20.5%) after SGB, lasting in about two-thirds of cases for over 24 hours with no major complications resulting from the SGB.

ObjectivesWe examined whether a home-based, adaptive cognitive training (CT) program would lead to cognitive performance changes on a neuropsychological test battery in cognitively normal older adults.MethodSixty-eight older adults (age = 70.0, SD = 3.74) were randomly assigned to either CT or an active control group (AC, casual computer games). Participants were instructed to train on their assigned programs for 42 min per day, 5 days per week, over 10 weeks (35 hr of total program usage). Participants completed tests of processing speed, working memory, and executive control before and after 10 weeks of training.ResultsTraining groups did not differ in performance before training. After training, CT participants out-performed AC participants in the overall cognitive composite score, driven by processing speed and working memory domains.DiscussionOur results show that a limited dose of home-based CT can drive cognitive improvements as measured with neuropsychological test battery, suggesting potential cognitive health maintenance implications for cognitively normal older adults.

Background In older adults, the linkage between laboratory-assessed ‘motor capacity’ and ‘mobility performance’ during daily routine is controversial. Understanding factors moderating this relationship could help developing more valid assessment as well as intervention approaches. We investigated whether the association between capacity and performance becomes evident with transition into frailty, that is, whether frailty status moderates their association. Methods We conducted a cross-sectional analysis of the observational (blinded for review) study in a community-dwelling cohort in (blinded for review). Participants were N = 112 older adults aged 65 years or older who were categorized as non-frail (n = 40), pre-frail (n = 53) or frail (n = 19) based on the Fried frailty index. Motor capacity was quantified as normal (NWS) and fast walking speed (FWS). Mobility performance was quantified as 1) cumulated physical activity (PA) time and 2) everyday walking performance (average steps per walking bout; maximal number of steps in one walking bout), measured by a motion sensor over a 48 h period. Hierarchical linear regression analyses were performed to evaluate moderation effects. Results Unlike in non-frail persons, the relationship between motor capacity and mobility performance was evident in pre-frail and frail persons, confirming our hypothesis. A moderating effect of frailty status was found for 1) the relationship between both NWS and FWS and maximal number of steps in one bout and 2) NWS and the average steps per bout. No moderation was found for the association between NWS and FWS with cumulated PA. Conclusion In pre-frail and frail persons, motor capacity is associated with everyday walking performance, indicating that functional capacity seems to better represent mobility performance in this impaired population. The limited relationship found in non-frail persons suggests that other factors account for their mobility performance. Our findings may help to inform tailored assessment approaches and interventions taking into consideration a person’s frailty status.

Background Primary pineal malignant melanoma is a rare type of primary central nervous system melanoma with only 19 cases reported in the literature. Case Report We present a case of a 53-year-old man with primary melanoma of the pineal region. He presented to the emergency department with gait unsteadiness and ataxia. Magnetic resonance imaging (MRI) revealed a 22 × 17 × 22-mm mass in the pineal region. On MRI the tumor was hyperintense in T1, isointense in T2, and on T1-weighted images with gadolinium enhancement it appeared homogeneously hyperintense with hypointense spots. Our patient underwent subtotal tumor resection as well as radiotherapy. The 52-week MRI control showed no recurrence of the lesion.After 62 weeks he developed gait ataxia and headaches and was admitted to the emergency department. Computed tomography revealed tumor bleeding and obstructive hydrocephalus.An external ventricular drain was placed, but the bleeding progressed, and 7 days after admission, MRI showed bleeding in the thalamus and mesencephalon. With a dismal prognosis, therapy was discontinued. He died 65 weeks after diagnosis. Methods We reviewed the available literature (PubMed) with 19 published cases of primary pineal malignant melanoma and evaluated the common symptoms at presentation, histopathologic features, radiologic findings, therapeutic regimens, and time of survival to provide the most up-to-date treatment. Results The median age of patients with primary pineal malignant melanoma is 52 years (female-to-male ratio: 10:10 years); a common first sign is chronic hydrocephalus. On MRI the lesion presents hyperintense in T1 and hypo- to isointense in T2. Biopsy or resection and histopathologic analysis are the key to diagnosis. Common histopathologic features are melanic pigment (n = 19/20), positive Human Melanoma Black (HMB-45) marker (n = 13/20), positive S100 protein reactivity (n = 11/20), as well as positive Melan-A (n = 9/20). The median survival was > 56.5 weeks in patients treated with resection and radiation. Conclusion Reconsidering the reported cases surgical treatment followed by radiation increases the length of survival.

This chapter will review the current state of knowledge on the effects of physical and mental (cognitive) training on hippocampal structure and function. We will primarily focus on normal aging and patient populations, though some relevant examples with young adults will also be described. Where possible, we will briefly review relevant research with animal models, in order to discuss potential mechanisms for beneficial effects of physical activity and cognitive training on hippocampal health.

was to determine the efficacy of Johrei as compared to wait-list in improving symptoms of FCP patients.Patients with chest pain of noncardiac origin for at least 3 months were enrolled into the study. All patients had to have negative upper endoscopy, pH testing and oesophageal manometry prior to randomization. Subsequently, patients were randomized to either Johrei or wait-list control. Patients received 18 Johrei sessions from a Johrei practitioner for 6 weeks.A total of 21 FCP patients enrolled into the Johrei group and 18 into the wait-list group. There was no difference in symptom intensity score between Johrei group and wait-list group at baseline (20.28 vs. 23.06, P = N.S.). However, there was a significant pre- and post-treatment reduction in symptom intensity in the Johrei group (20.28 vs. 7.0, P = 0.0023). There was no significant reduction in symptom intensity score between baseline and at the end of the study in the wait-list group (23.06 vs. 20.69, P = N.S.).This pilot study shows that Johrei may have a role in improving FCP symptoms; however, future studies are needed to compare Johrei treatment with sham Johrei or supportive care.

Energy storage devices based on reversible solid oxide cell technology has been shown to offer roundtrip efficiencies exceeding 70%. This technology can operate sequentially in both electrolysis and fuel cell modes to compete with advanced batteries, compressed air, and pumped hydro energy storage methods. Achieving competitive performance with reversible solid oxide cells (ReSOC) requires advancement in both materials and system design to enable efficient and inexpensive operation. The unique characteristics of solid oxide cells (i.e. high temperature, carbonaceous reactants) allow them to exceed the roundtrip energy storage efficiency of typical low-temperature reversible fuel cells. This study explores different system configurations and operating conditions in order to evaluate the technical potential of ReSOCs to compete with present and future energy storage technologies. Fig. 1 shows a simplified schematic of the envisioned process. The system operates in either fuel cell (SOFC) or electrolysis (SOEC) modes with intermediate tanked storage of reactants and products. The energy storage system charges by operating the ReSOC stack as an electrolyser, in which exhaust species – primarily H2O and CO2– are discharged from a storage tank, heated, delivered to the stack, and co-electrolyzed to produce a fuel mixture with an input of electricity. The generated fuel is cooled and compressed to a separate storage tank for later use. The system discharges by operating in SOFC mode, in which the tanked fuel mixture is preheated, delivered to the stack and electrochemically oxidized, producing electricity and exhaust species to re-fill the exhaust tank. An oxidant flow is required in the SOFC mode to provide oxygen for the electrochemical reactions and regulate stack temperature. In SOEC mode, the airflow acts as a sweep gas to increase electrical efficiency by diluting generated oxygen in the oxygen channel and serves as a heat sink for exothermic operation. Some unique challenges arise in designing ReSOC systems, including: (i) overcoming the thermal disparity between fuel cell (typically exothermic) and electrolysis (typically endothermic or near thermoneutral) operation using a unitized cell-stack and common hardware, (ii) selecting configurations and operating conditions (T, p, utilization, composition) that promote high efficiency in both operating modes, and (iii) thermal integration between high temperature stack operation and lower temperature, pressurized storage. Furthermore, because reaction products are tanked for use in the opposite mode of operation, they must be processed to enable compression to storage pressure with minimal energetic cost. ReSOC systems simplify system thermal management by combining co-electrolysis with in-situ fuel synthesis (i.e., methanation) and electrochemical oxidation with internal fuel reforming such that the stack is slightly exothermic in both SOFC and SOEC modes. By using this strategy, the cell can operate exothermically at electrolysis voltages that would otherwise be endothermic, enabling increased electrical efficiency without utilizing an external heat source. This approach enables high efficiency and thermally self-sustaining operation, but requires operating the ReSOC stack under conditions that promote methane formation in electrolysis mode. Methanation is catalysed on nickel present in the ReSOC fuel electrode and is promoted by low temperature and high pressure stack operation. Our previous analyses have demonstrated the potential for roundtrip efficiencies of nearly 74% with 20-40 kWh/m3 tanked energy density depending on the type of water management employed in the system. Separately storing condensed water increases energy density of storage to 38 kWh/m3, but limits efficiency to 68% based on the energetic cost of evaporating reactant water during electrolysis operation. Further increases in energy density (to 90 kWh/m3) require higher storage pressures (e.g., 50-bar nominal) which lower roundtrip efficiency to about 65%. To be competitive with advanced batteries such as sodium sulphur and vanadium redox flow batteries, ReSOC technology would benefit from higher energy storage density. In the present work, we explore system design strategies which integrate methanation reactors to achieve >300% increase in volumetric energy density while roundtrip efficiency exceeds 68%. The ReSOC technology explored within the present study is based on intermediate temperature (600-650°C) LSGM cells on SLT supports and nickel nano-particle infiltrated fuel electrodes for enhanced triple-phase boundary areas which lead to high power density. System design and operational modes are discussed, along with significant balance-of-plant thermal integration and performance analysis. The resulting energy density of the system for modest tank storage pressures of 25 bar exceeds 130 kWh/m3. Figure 1

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Background/Aims Rectal cancer surgery includes a colostomy (or ileostomy) or, more frequently, anastomosis of the rectum. Both surgery types may create long-term after-effects. We examined differences reported between survivors with ostomies versus anastomoses regarding levels of work, volunteering, and financial burdens, and how much they perceived their cancer operations affected these experiences.

A 48-year-old man with surgically removed adrenal cell carcinoma presented with shortness of breath and fatigue. Physical examination revealed neck vein distention and a new systolic murmur. Echocardiography showed a right ventricular mass causing inflow and outflow tract obstruction. These findings were confirmed at surgery.