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Background: Brain tumors present unique challenges to patient and family quality of life (QOL). Cognitive dysfunction is common and functionally limiting, with no established treatments. These studies evaluate feasibility and preliminary efficacy of behavioral interventions developed for neuro-oncology patients. Study 1: A randomized controlled trial (N=25 primary brain tumor patients) compared an adapted version of Goal Management Training (GMT, a neuroscience-based integration of mindfulness and strategy training) and a newly-designed supportive psychoeducational intervention (Brain Health Program, BHP) to standard of care. Each intervention comprised 8 individual sessions and at-home practice between sessions. GMT patients’ executive functions improved immediately (p=.077, d=1.13), with maintenance at 4-month follow-up (p=.046, d=1.09). Both intervention groups reported improvements in everyday cognitive functioning immediately (p=.049; d’s GMT=0.43, BHP=0.79) and at follow-up (p=.001; d’s GMT=0.22, BHP=1.01). BHP patients also reported improved mood (p’s=.026 & .012, d’s=0.61 & 0.62). Study 2: Following a needs assessment about cognitive concerns and QOL in brain metastases patients (N=109) and caregivers (N=31), we developed a novel, brief (3 sessions + homework) Cognitive Support Program to provide education and strategy-training in key areas of concern: executive functions, memory, and communication. Options include caregiver co-training, and in-person or web-based delivery. Preliminary data from a pilot trial in progress demonstrate objective and subjective improvements. Conclusions: Cognitive rehabilitation may be a feasible and effective option for primary or metastatic brain tumor patients, addressing a need that is largely unmet in standard cancer care. Further development and larger trials appear warranted, with capacity for remote delivery recommended.
To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection devices in other hospitals
Multicenter cluster randomized trial
SETTING AND PARTICIPANTS
Nine hospitals in the southeastern United States
All participating hospitals developed systems to implement 4 different strategies for terminal room disinfection. We measured compliance with disinfection strategy, barriers to implementation, and perceptions from nurse managers and environmental services (EVS) supervisors throughout the 28-month trial.
Implementation of enhanced terminal disinfection with UV disinfection devices provides unique challenges, including time pressures from bed control personnel, efficient room identification, negative perceptions from nurse managers, and discharge volume. In the course of the BETR Disinfection Study, we utilized several strategies to overcome these barriers: (1) establishing safety as the priority; (2) improving communication between EVS, bed control, and hospital administration; (3) ensuring availability of necessary resources; and (4) tracking and providing feedback on compliance. Using these strategies, we deployed ultraviolet (UV) disinfection devices in 16,220 (88%) of 18,411 eligible rooms during our trial (median per hospital, 89%; IQR, 86%–92%).
Implementation of enhanced terminal room disinfection strategies using UV devices requires recognition and mitigation of 2 key barriers: (1) timely and accurate identification of rooms that would benefit from enhanced terminal disinfection and (2) overcoming time constraints to allow EVS cleaning staff sufficient time to properly employ enhanced terminal disinfection methods.
To evaluate a computer-assisted point-prevalence survey (CAPPS) for hospital-acquired infections (HAIs).
A 754-bed teaching hospital in the Netherlands.
For the internal validation of a CAPPS for HAIs, 2,526 patients were included. All patient records were retrospectively reviewed in depth by 2 infection control practitioners (ICPs) to determine which patients had suffered an HAI. Preventie van Ziekenhuisinfecties door Surveillance (PREZIES) criteria were used. Following this internal validation, 13 consecutive CAPPS were performed in a prospective study from January to March 2013 to determine weekly, monthly, and quarterly HAI point prevalence. Finally, a CAPPS was externally validated by PREZIES (Rijksinstituut voor Volksgezondheid en Milieu [RIVM], Bilthoven, Netherlands). In all evaluations, discrepancies were resolved by consensus.
In our series of CAPPS, 83% of the patients were automatically excluded from detailed review by the ICP. The sensitivity of the method was 91%. The time spent per hospital-wide CAPPS was ~3 hours. External validation showed a negative predictive value of 99.1% for CAPPS.
CAPPS proved to be a sensitive, accurate, and efficient method to determine serial weekly point-prevalence HAI rates in our hospital.
This paper briefly describes the principle of operation and science goals of the AMANDA high energy neutrino telescope located at the South Pole, Antarctica. Results from an earlier phase of the telescope, called AMANDA-BIO, demonstrate both reliable operation and the broad astrophysical reach of this device, which includes searches for a variety of sources of ultrahigh energy neutrinos: generic point sources, Gamma-Ray Bursts and diffuse sources. The predicted sensitivity and angular resolution of the telescope were confirmed by studies of atmospheric muon and neutrino backgrounds. We also report on the status of the analysis from AMANDA-II, a larger version with far greater capabilities. At this stage of analysis, details of the ice properties and other systematic uncertainties of the AMANDA-II telescope are under study, but we have made progress toward critical science objectives. In particular, we present the first preliminary flux limits from AMANDA-II on the search for continuous emission from astrophysical point sources, and report on the search for correlated neutrino emission from Gamma Ray Bursts detected by BATSE before decommissioning in May 2000. During the next two years, we expect to exploit the full potential of AMANDA-II with the installation of a new data acquisition system that records full waveforms from the in-ice optical sensors.
In this pilot study, we evaluate an algorithm that uses predictive clinical and laboratory parameters to differentiate between patients with hospital-acquired infection (HAI) and patients without HAI. Seventy-four percent of the studied population of surgical patients could be reliably (negative predictive value of 98%) excluded from detailed assessment by the infection control practitioner.
Surveillance of hospital-acquired infections can be approximated by repeated surveys that are performed in a standardized, cost-effective manner. We developed an integrated software system for serial electronic hospital-wide point prevalence surveys using algorithms that proved highly sensitive and specific over a 5-year period in a large university medical center.
Choline is an essential nutrient that is found in many food sources and plays a critical role in the development of the central nervous system. Animal studies have shown that choline status pre- and postnatally can have long-lasting effects on attention and memory; however, effects in human subjects have not been well studied. The aim of the present study was to examine the association between plasma concentrations of free choline and its related metabolites in children and their neurodevelopment in the Seychelles Child Development Nutrition Study, an ongoing longitudinal study assessing the development of children born to mothers with high fish consumption during pregnancy. Plasma concentrations of free choline, betaine, dimethylglycine (DMG), methionine and homocysteine and specific measures of neurodevelopment were measured in 210 children aged 5 years. The children's plasma free choline concentration (9·17 (sd 2·09) μmol/l) was moderately, but significantly, correlated with betaine (r 0·24; P= 0·0006), DMG (r 0·15; P= 0·03), methionine (r 0·24; P= 0·0005) and homocysteine (r 0·19; P= 0·006) concentrations. Adjusted multiple linear regression revealed that betaine concentrations were positively associated with Preschool Language Scale – total language scores (β = 0·066; P= 0·04), but no other associations were evident. We found no indication that free choline concentration or its metabolites, within the normal physiological range, are associated with neurodevelopmental outcomes in children at 5 years of age. As there is considerable animal evidence suggesting that choline status during development is associated with cognitive outcome, the issue deserves further study in other cohorts.
Cryptosporidium is a zoonotic protozoan parasite with public health importance worldwide. The objectives of this study were to (1) conduct a meta-analysis of published literature for oocyst shedding and diarrhoea outcomes, and (2) develop recommendations for standardization of experimental dose–response studies. Results showed that for the outcome of oocyst shedding in faeces, the covariates ‘experimental species’, ‘immunosuppression’, ‘oocyst dose’ and ‘oocyst dose’ × ‘age’ were all significant (P ⩽ 0·05). This study suggests that exposing mice, piglets, or ruminants, and using immunosuppressed experimental hosts, is more likely to result in oocyst shedding. For the outcome of diarrhoea in experimentally infected animal species, the key covariates ‘experimental species’, ‘age’ and ‘immunosuppression’ were significant (P ⩽ 0·2). Therefore, based on the results of this meta-analysis, these variables should be carefully reported and considered when designing experimental dose–response studies. Additionally, detection of possible publication bias highlights the need to publish additional studies that convey statistically non-significant as well as significant results in the future.
To assess the nutritional adequacy of Seychellois children in relation to nutrients reported to be important for cognitive development.
Dietary intakes were assessed by 4 d weighed food diaries and analysed using dietary analysis software (WISP version 3·0; Tinuviel Software, UK). Individual nutrient intakes were adjusted to usual intakes and, in order to investigate adequacy, were compared with the UK Estimated Average Requirements for children aged 4–6 years.
Children 5 years old were followed up as part of the Seychelles Child Development Nutrition Study (SCDNS), located in the high-fish-consuming population of Mahé, Republic of Seychelles.
Analysis was carried out on a sample of 229 children (118 boys, 111 girls).
Children consumed a diet of which fortified cereal and milk products contributed the most to nutrient intakes. The majority (≥80 %) of children met requirements for several nutrients important for child development including Fe, folate and Se. Adjusted dietary intakes of Cu, Zn, iodine, niacin and vitamin A were below the Estimated Average Requirement or Recommended Nutrient Intake. Mean adjusted energy intakes (boys 4769 kJ/d (1139·84 kcal/d), girls 4759 kJ/d (1137·43 kcal/d)) were lower than the estimated energy requirement (boys 5104 kJ/d (1220 kcal/d), girls 5042 kJ/d (1205 kcal/d)) for 88 % of boys and 86 % of girls.
Nutrition was adequate for most children within the SCDNS cohort. Low intakes of some nutrients (including Zn, niacin and vitamin A) could reflect nutritional database inaccuracies, but may require further investigation. The study provides valuable information on the adequacy of intakes of nutrients which could affect the growth and development of Seychellois children.
As in the past, the primary activity of the IAU Working Group on Cartographic Coordinates and Rotational Elements has been to prepare and publish a triennial (“2009”) report containing current recommendations for models for Solar System bodies (Archinal et al. (2011a)). The authors are B. A. Archinal, M. F. A'Hearn, E. Bowell, A. Conrad, G. J. Consolmagno, R. Courtin, T. Fukushima, D. Hestroffer, J. L. Hilton, G. A. Krasinsky, G. Neumann, J. Oberst, P. K. Seidelmann, P. Stooke, D. J. Tholen, P. C. Thomas, and I. P. Williams. An erratum to the “2006” and “2009” reports has also been published (Archinal et al. (2011b)). Below we briefly summarize the contents of the 2009 report, a plan to consider requests for new recommendations more often than every three years, three general recommendations by the WG to the planetary community, other WG activities, and plans for our next report.
Ni-Ti films were bombarded by plasma source heavy ions of different ion dose and ion flux. Disc-like non-uniform microstructures were found when the films were irradiated at a dose of 5x1016Kr+/cm2. These “discs” were acting as defect centers. The development of “discs” depended on the plasma ion flux during the pulse. Target geometry appeared to have effects on the density of “discs”.
A new facility is operational at Los Alamos to examine plasma source ion implantation on a large scale. Large workpieces can be treated in a 1.5-m-diameter, 4.6-m-Jong plasma vacuum chamber. Primary emphasis is directed towards improving tribological properties of metal surfaces. First experiments have been performed at 40 kV with nitrogen plasmas. Both coupons and manufactured components, with surface areas up to 4 m2, have been processed. Composition and surface hardness of implanted materials are evaluated. Implant conformality and dose uniformity into practical geometries are estimated with multidimensional particle-in-cell computations of plasma electron and ion dynamics, and Monte Carlo simulations of ion transport in solids.
Copper and aluminum are extensively used in various parts of the Electromagnetic (EM) Gun systems. Copper is used in the design of the railgun because it has favorable electrical and thermal properties. Aluminum is used for armature and sabot fabrication because of it is light weight and has favorable thermal properties. Extensive degradation of the copper rail and aluminum armature occurs owing to the severe heating and thermomechanical deformation of these components during operation of the EM gun. In this research effort, several modification techniques were used to protect the rail and armature materials from these degradation processes. These include application of Plasma Source Ion Implantation (PSII) and Ion Beam Enhanced Deposition (IBED) . By using these techniques, the copper rails and aluminum armatures were coated with TiN and TaN. Several characterization techniques were used to assess the chemical,mechanical and other properties of these modified surfaces. Optical Microscopy, Scanning and Transmission Electron Microscopy, and Scanning Auger Spectroscopy techniques were also used. Microhardness measurements have also been performed. From the results of this preliminary investigation, it has been concluded that the surface properties of the coated rail and armature materials have been improved and the extent of wear and spark erosion from these surfaces has been reduced.
The spreading of molten 60Sn40Pb drops on higher melting point Pb-Sn alloy substrates (3 to 10 wt.% Sn) was investigated for reflow temperatures of 205° to 300°C. Following melting the drop assumed the form of a slightly flared, spherical cap with some penetration into the substrate beneath the contact area. The effects of time and temperature on the contact angle θ and the depth of penetration h were of the form
where the apparent activation energy Q was 4.2 kcal/mole for θ and 16 kcal/mole for h. The time exponent m (negative for θ and positive for h) decreased with temperature from ∼ 0.2–0.3 at 205°C to ∼0.05 at 260° and then increased again at higher temperatures. The magnitude of Q for θ is in accord with that for the viscosity of molten Pb-Sn alloys and that for h with a combined liquid-solid diffusion involved in the dissolution. Further work is however needed to identify unequivocally the mechanisms which govern the wetting in these duplex Pb-Sn alloy systems.
Microcrystalline silicon (μc-Si) films were prepared by electron cyclotron resonance assisted chemical vapor deposition (ECRCVD) using helium, argon and hydrogen dilution. The crystalline fraction was estimated from Raman backscattering spectra and scanning electron-microscopy (SEM) was used to obtain information on roughness and homogeneity of the films. For hydrogen dilution the highest crystallinity (Xc = 85 %) occurs at a ratio of ΔH = [H2]/([H2]+[SiH4])= 0.98. At the same time the deposition rate decreases continuously with increasing H2 dilution. These results are consistent with the idea that H etching promotes the growth of μc-Si. At ΔH > 0.98 a Xc decreases due to a H mediated transition of small crystallites into amorphous tissue. The implications of these results for the growth mechanisms are discussed.
The status of our knowledge on intrinsic point defects and diffusion mechanisms is reviewed. Special attention is given to the question of the possible role of carbon in influencing effective diffusivities of intrinsic point defects and the resulting consequences for the values of vacancy and self-interstitial thermal equilibrium concentrations and diffusivities. It is pointed out that we might have to deal with the unfortunate situation that the effective diffusivities of intrinsic point defects might be influenced already by a carbon concentration which is below the detection limit and therefore not amenable to measurement and control. Whereas dopant diffusion processes have been modeled and simulated for a long time the first attempts to quantitatively simulate various gettering processes have just started as will be described in the paper. Finally, the subject of microcrack formation in hydrogen implanted silicon will be dealt with as used for the so-called “smart-cut” process for fabricating silicon-on-insulator (SOI) substrates with thin and uniform silicon layers by wafer bonding. Presently no quantitative treatment of this fascinating hydrogen agglomeration phenomenon is available.
The dodecagonal (dd) quasicrystalline tantalum telluride dd Ta1.6Te and the crystalline approximant Ta97Te60 have been modified by partly replacing tantalum by vanadium. The impact of the substitution on the structures has been studied by X-ray and electron diffraction and by high-resolution transmission electron microscopy. The layered-type approximant structure of Ta83V14Te60 was determined by single crystal X-ray means. The partitioning of vanadium on 21 out of 29 crystallographically inequivalent metal sites is referred to, but not controlled by the Dirichlet domain volume available at the sites. A HRTEM projection of dd (Ta, V)1.6Te onto the dodecagonal plane is analysed with respect to the arrangement of (Ta, V)151Te74 clusters on the vertices of an irregular aperiodic square-triangle tiling, the edge length of which corresponds to the distance between the centres of two such clusters. The clusters comprise about 1 nm thick corrugated lamellae which are periodically stacked by weak Te-Te interactions.