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Background: Handovers during medical emergencies are challenging due to time-critical, dynamic and oftentimes unorderly and distracting situations. We evaluated the effect of distraction-reduced clinical surroundings during handover on (1) the recall of handover information, (2) the recall of information from the surroundings and (3) self-reported workload in a simulated in-hospital cardiac arrest scenario. Methods: In a parallel group design, emergency team leaders were randomly assigned to receive a structured handover of a cardio-pulmonary resuscitation (CPR) either inside the room (“inside group”) right next to the ongoing CPR or in front of the room (“outside group”) with no audio-visual distractions from the ongoing CPR. Based on the concept of situation awareness, the primary outcome was a handover score for the content of the handover (0–19 points) derived from the pieces of information given during handover. Furthermore, we assessed team leaders’ perception of their surroundings during the scenario (0–5 points) and they rated their subjective workload using the NASA Task Load Index. Results: The outside group (n = 30) showed significant better recall of handover information than the inside group (n = 30; mean difference = 1.86, 95% CI = 0.67 to 3.06, p = 0.003). The perception of the surroundings (n = 60; mean difference = −0.27, 95% CI = −0.85 to 0.32, p = 0.365) and the NASA Task Load Index (n = 58; mean difference = 1.1; p = 0.112) did not differ between the groups. Conclusions: Concerning in-hospital emergencies, a structured handover in a distraction reduced environment can improve information uptake of the team leader.

The academic and industrial communities have proposed two-dimensional (2D) transition metal dichalcogenide (TMD) semiconductors as a future option to supplant silicon transistors at sub-10nm physical gate lengths. In this Comment, we share the recent progress in the fabrication of complementary metal-oxide-semiconductor (CMOS) devices based on stacked 2D TMD nanoribbons and specifically highlight issues that still need to be resolved by the 2D community in five crucial research areas: contacts, channel growth, gate oxide, variability, and doping. While 2D TMD transistors have great potential, more research is needed to understand the physical interactions of 2D materials at the atomic scale.

The authors introduce an augmented-basis method (ABM) to stabilize reduced-order models (ROMs) of turbulent incompressible flows. The method begins with standard basis functions derived from proper orthogonal decomposition (POD) of snapshot sets taken from a full-order model. These are then augmented with divergence-free projections of a subset of the nonlinear interaction terms that constitute a significant fraction of the time-derivative of the solution. The augmenting bases, which are rich in localized high wavenumber content, are better able to dissipate turbulent kinetic energy than the standard POD bases. Several examples illustrate that the ABM significantly out-performs L2-, H1- and Leray-stabilized POD ROM approaches. The ABM yields accuracy that is comparable to constraint-based stabilization approaches yet is suitable for parametric model-order reduction in which one uses the ROM to evaluate quantities of interests at parameter values that differ from those used to generate the full-order model snapshots. Several numerical experiments point to the importance of localized high wavenumber content in the generation of stable, accurate, and efficient ROMs for turbulent flows.

A time-averaged error indicator with POD-hGreedy is developed to drive parametric model order reduction (pMOR) for 2D unsteady natural convection in a high-aspect ratio slot parameterized with the Prandtl number, Rayleigh number, and slot angle with respect to the gravity. The error indicator is extended to accommodate the energy equation and Leray regularization. Despite being two-dimensional and laminar, the target flow regime presents several challenges: 1) there is a bifurcation in the angle parameter space; 2) the solution can be multivalued, even at steady state; and 3) the solution exhibits spatio-temporal chaos at several points in the parameter space. The authors explore several reduced-order models (ROMs) and demonstrate that Leray-regularized Galerkin ROMs provide a robust solution approach for this class of flows. They further demonstrate that error-indicated pMOR can efficiently predict several QOIs, such as mean flow, mean Nusselt number and mean turbulent kinetic energy, even in the presence of a bifurcation. Finally, they show that spatio-temporal chaos can lead to lack of reproducibility in both the full-order model and the reduced-order model and that the variance in the full-order model provides a lower bound on the pMOR error in these cases.

Magnetic Resonance Imaging (MRI) offers strong soft tissue contrast but suffers from long acquisition times and requires tedious annotation from radiologists. Traditionally, these challenges have been addressed separately with reconstruction and image analysis algorithms. To see if performance could be improved by treating both as end-to-end, we hosted the K2S challenge, in which challenge participants segmented knee bones and cartilage from 8× undersampled k-space. We curated the 300-patient K2S dataset of multicoil raw k-space and radiologist quality-checked segmentations. 87 teams registered for the challenge and there were 12 submissions, varying in methodologies from serial reconstruction and segmentation to end-to-end networks to another that eschewed a reconstruction algorithm altogether. Four teams produced strong submissions, with the winner having a weighted Dice Similarity Coefficient of 0.910 ± 0.021 across knee bones and cartilage. Interestingly, there was no correlation between reconstruction and segmentation metrics. Further analysis showed the top four submissions were suitable for downstream biomarker analysis, largely preserving cartilage thicknesses and key bone shape features with respect to ground truth. K2S thus showed the value in considering reconstruction and image analysis as end-to-end tasks, as this leaves room for optimization while more realistically reflecting the long-term use case of tools being developed by the MR community.

Enzymerhodopsins represent a recently discovered class of rhodopsins which includes histidine kinase rhodopsin, rhodopsin phosphodiesterases, and rhodopsin guanylyl cyclases (RGCs). The regulatory influence of the rhodopsin domain on the enzyme activity is only partially understood and holds the key for a deeper understanding of intra-molecular signaling pathways. Here, we present a UV-Vis and FTIR study about the light-induced dynamics of a RGC from the fungus Catenaria anguillulae, which provides insights into the catalytic process. After the spectroscopic characterization of the late rhodopsin photoproducts, we analyzed truncated variants and revealed the involvement of the cytosolic N-terminus in the structural rearrangements upon photo-activation of the protein. We tracked the catalytic reaction of RGC and the free GC domain independently by UV-light induced release of GTP from the photolabile NPE-GTP substrate. Our results show substrate binding to the dark-adapted RGC and GC alike and reveal differences between the constructs attributable to the regulatory influence of the rhodopsin on the conformation of the binding pocket. By monitoring the phosphate rearrangement during cGMP and pyrophosphate formation in light-activated RGC, we were able to confirm the M state as the active state of the protein. The described setup and experimental design enable real-time monitoring of substrate turnover in light-activated enzymes on a molecular scale, thus opening the pathway to a deeper understanding of enzyme activity and protein-protein interactions.

Carbon-cluster ions are produced by laser irradiation of glassy carbon in high vacuum. In the case of positively charged species, a bimodal cluster distribution including fullerenes with cluster-size-to-charge ratios of up to a few hundred is observed. Resolving isotopologues by use of a multireflection time-of-flight mass spectrometer allows the detection and abundance determination of multiply charged clusters. It is found that mono-, di-, and tricationic fullerenes are produced, have similar size-over-charge-state ranges, and follow log-normal distributions known to be characteristic of an underlying coalescent growth. A statistical simulation is shown to reproduce the results.

Abstract Channelrhodopsins (ChRs) are algal light-gated ion channels widely used as optogenetic tools for manipulating neuronal activity. ChRs desensitize under continuous bright-light illumination, resulting in a significant decline of photocurrents. Here we describe a metagenomically identified family of phylogenetically distinct anion-conducting ChRs (designated MerMAIDs). MerMAIDs almost completely desensitize during continuous illumination due to accumulation of a late non-conducting photointermediate that disrupts the ion permeation pathway. MerMAID desensitization can be fully explained by a single photocycle in which a long-lived desensitized state follows the short-lived conducting state. A conserved cysteine is the critical factor in desensitization, as its mutation results in recovery of large stationary photocurrents. The rapid desensitization of MerMAIDs enables their use as optogenetic silencers for transient suppression of individual action potentials without affecting subsequent spiking during continuous illumination. Our results could facilitate the development of optogenetic tools from metagenomic databases and enhance general understanding of ChR function.

The heaviest actinide elements are only accessible in accelerator-based experiments on a one-atom-at-a-time level. Usually, fusion–evaporation reactions are applied to reach these elements. However, access to the neutron-rich isotopes is limited. An alternative reaction mechanism to fusion–evaporation is multinucleon transfer, which features higher cross-sections. The main drawback of this technique is the wide angular distribution of the transfer products, which makes it challenging to catch and prepare them for precision measurements. To overcome this obstacle, we are building the NEXT experiment: a solenoid magnet is used to separate the different transfer products and to focus those of interest into a gas-catcher, where they are slowed down. From the gas-catcher, the ions are transferred and bunched by a stacked-ring ion guide into a multi-reflection time-of-flight mass spectrometer (MR-ToF MS). The MR-ToF MS provides isobaric separation and allows for precision mass measurements. In this article, we will give an overview of the NEXT experiment and its perspectives for future actinide research.

Indium-cluster anions In_{n}^{−} are probed for delayed dissociation by photoexcitation in a multi-reflection time-of-flight device. In addition to prompt dissociation with below-microsecond decay constants, we observe reactions on timescales of several tens to hundreds of microseconds. These time-resolved decay-rate measurements reveal a power-law behavior in time which can be traced back to the clusters' energy distribution due to their production by laser ablation in high vacuum. Modeling energy distributions from such a production allows us to connect the cluster-specific dissociation energy with the ensemble temperature through experimentally determined power-law exponents.

Checkpoint inhibitors target the inhibitory receptors expressed by tumor-infiltrating T cells in order to reinvigorate an anti-tumor immune response. Therefore, understanding T cell composition and phenotype in human tumors is crucial. We analyzed by flow cytometry tumor-infiltrating lymphocytes (TILs) from two independent cohorts of patients with different cancer types, including RCC, lung, and colon cancer. In healthy donors, peripheral T cells are usually either CD4+ or CD8+ with a small percentage of CD4+ CD8+ DP cells (5%, reaching 30–50% of T cells in some patients). These DP T cells have an effector memory phenotype and express CD38, 4-1BB, and HLA-DR, suggesting antigen-driven expansion. In fact, TCR sequencing analysis revealed a high degree of clonality in DP T cells. Additionally, there were high levels of PD-1 and TIM-3 expression on DP T cells, which correlated with higher expression of PD-1 and TIM-3 in conventional single positive CD8 T cells from the same patients. These results suggest that DP T cells could be dysfunctional tumor-specific T cells with the potential to be reactivated by checkpoint inhibitors.

Agents targeting the PD1–PDL1 axis have transformed cancer therapy. Factors that influence clinical response to PD1–PDL1 inhibitors include tumor mutational burden, immune infiltration of the tumor, and local PDL1 expression. To identify peripheral correlates of the anti-tumor immune response in the absence of checkpoint blockade, we performed a retrospective study of circulating T cell subpopulations and matched tumor gene expression in melanoma and non-small cell lung cancer (NSCLC) patients. Notably, both melanoma and NSCLC patients whose tumors exhibited increased inflammatory gene transcripts presented high CD4+ and CD8+ central memory T cell (CM) to effector T cell (Eff) ratios in blood. Consequently, we evaluated CM/Eff T cell ratios in a second cohort of NSCLC. The data showed that high CM/Eff T cell ratios correlated with increased tumor PDL1 expression. Furthermore, of the 22 patients within this NSCLC cohort who received nivolumab, those with high CM/Eff T cell ratios, had longer progression-free survival (PFS) (median survival: 91 vs. 215 days). These findings show that by providing a window into the state of the immune system, peripheral T cell subpopulations inform about the state of the anti-tumor immune response and identify potential blood biomarkers of clinical response to checkpoint inhibitors in melanoma and NSCLC.

The photofragmentation behavior of the lead-doped bismuth cluster ^{209}Bi_{7}^{208}Pb^{+} is investigated by use of multi-reflection time-of-flight mass spectrometry (MR-ToF MS), which serves both as precursor selector on a scale of single atomic mass units as well as high-resolution fragment analyzer. This is an implementation of a tandem MR-ToF study, where two instances of high-resolution mass spectrometry are used, namely for pre-selection and post-excitation analysis, in quick succession within a single device to determine complex dissociation patterns. The full information of the fragmentation pathways is obtained, including branching ratios describing the retention of the charge on the pure or compound cluster. The results are compared to the behavior of the analogous pure bismuth cluster ^{209}Bi_{8}^{+} and interpreted within the framework of well-established cluster stability rules.

Elevated or reduced velocity of cerebrospinal fluid (CSF) at the craniovertebral junction (CVJ) has been associated with type I Chiari malformation (CMI). Thus, quantification of hydrodynamic parameters that describe the CSF dynamics could help assess disease severity and surgical outcome. In this study, we describe the methodology to quantify CSF hydrodynamic parameters near the CVJ and upper cervical spine utilizing subject-specific computational fluid dynamics (CFD) simulations based on in vivo MRI measurements of flow and geometry. Hydrodynamic parameters were computed for a healthy subject and two CMI patients both pre- and post-decompression surgery to determine the differences between cases. For the first time, we present the methods to quantify longitudinal impedance (LI) to CSF motion, a subject-specific hydrodynamic parameter that may have value to help quantify the CSF flow blockage severity in CMI. In addition, the following hydrodynamic parameters were quantified for each case: maximum velocity in systole and diastole, Reynolds and Womersley number, and peak pressure drop during the CSF cardiac flow cycle. The following geometric parameters were quantified: cross-sectional area and hydraulic diameter of the spinal subarachnoid space (SAS). The mean values of the geometric parameters increased post-surgically for the CMI models, but remained smaller than the healthy volunteer. All hydrodynamic parameters, except pressure drop, decreased post-surgically for the CMI patients, but remained greater than in the healthy case. Peak pressure drop alterations were mixed. To our knowledge this study represents the first subject-specific CFD simulation of CMI decompression surgery and quantification of LI in the CSF space. Further study in a larger patient and control group is needed to determine if the presented geometric and/or hydrodynamic parameters are helpful for surgical planning.