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Antarctica's ice shelves modulate the grounded ice flow, and weakening of ice shelves due to climate forcing will decrease their ‘buttressing’ effect, causing a response in the grounded ice. While the processes governing ice-shelf weakening are complex, uncertainties in the response of the grounded ice sheet are also difficult to assess. The Antarctic BUttressing Model Intercomparison Project (ABUMIP) compares ice-sheet model responses to decrease in buttressing by investigating the ‘end-member’ scenario of total and sustained loss of ice shelves. Although unrealistic, this scenario enables gauging the sensitivity of an ensemble of 15 ice-sheet models to a total loss of buttressing, hence exhibiting the full potential of marine ice-sheet instability. All models predict that this scenario leads to multi-metre (1–12 m) sea-level rise over 500 years from present day. West Antarctic ice sheet collapse alone leads to a 1.91–5.08 m sea-level rise due to the marine ice-sheet instability. Mass loss rates are a strong function of the sliding/friction law, with plastic laws cause a further destabilization of the Aurora and Wilkes Subglacial Basins, East Antarctica. Improvements to marine ice-sheet models have greatly reduced variability between modelled ice-sheet responses to extreme ice-shelf loss, e.g. compared to the SeaRISE assessments.
Data about quality of life (QoL) are important to estimate the impact of diseases on functioning and well-being. The present study was designed to assess the association of different aspects of panic disorder (PD) with QoL and to examine the relationship between QoL and symptomatic outcome following brief cognitive-behavioral group therapy (CBGT).
Methods
The sample consisted of 55 consecutively recruited outpatients suffering from PD who underwent CBGT. QoL was assessed by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) at baseline, post-treatment and six months follow-up. SF-36 baseline scores were compared with normative data obtained from a large German population sample.
Results
Agoraphobia, disability, and worries about health were significantly associated with decreased QoL, whereas frequency, severity and duration of panic attacks were not. Treatment responders showed significantly better QoL than non-responders. PD symptom reduction following CBGT was associated with considerable improvement in emotional and physical aspects of QoL. However, the vitality subscale of the SF-36 remained largely unchanged over time.
Conclusions
Our results are encouraging for cognitive-behavior therapists who treat patients suffering from PD in groups, since decrease of PD symptoms appears to be associated with considerable improvements in QoL. Nevertheless, additional interventions designed to target specific aspects of QoL, in particular vitality, may be useful to enhance patients’ well-being.
Some studies have shown that alexithymic patients respond poorly to pharmacotherapy and that alexithymia may have a negative impact on the naturalistic course of psychiatric illnesses. The view that alexithymic patients are also less responsive to psychotherapy is often described in the literature, but few empirical studies have examined this issue, with inconsistent results.
Methods:
We conducted two prospective studies (pre/post/follow-up) with patients with panic disorder and obsessive-compulsive disorder, to evaluate alexithymia as a potential predictor of the outcome of cognitive-behavioral therapy (CBT) including exposure response management. A further aim was to examine the absolute and relative stability of alexithymia.
Results:
Regression analyses revealed that alexithymia, as measured with the 20-item Toronto Alexithymia Scale, was related neither to the post-treatment nor to the follow-up outcome. The repeated measures ANOVA showed a significant decrease of alexithymia over time, even after controlling for depression. The high test-retest correlations of alexithymia total and factor scores indicated relative stability of this construct, suggesting that it is a stable personality trait rather than a state-dependent phenomenon in these patients.
Conclusions:
The results are encouraging for cognitive-behavior therapists working with alexithymic patients with panic disorder and obsessive-compulsive disorder, since the CBT outcome of these patients does not appear to be negatively affected by alexithymia. Furthermore, some alexithymic characteristics may decrease during CBT, even when the therapy program is not specifically directed to alexithymia. Future controlled studies should examine whether these improvements of alexithymia are due to psychotherapeutic interventions, in particular exposure therapy.
Sleep problems in children with common psychiatric disorders present a considerable challenge for clinicians in developing effective diagnosis and treatment strategies. Whilst sleep-disordered breathing (SDB) and periodic leg movements in sleep (PLMS) are very frequent in children with attention-deficit/hyperactivity disorder (ADHD) which can deviate sleep architecture, their co-existence in Tic disorder (TD) and ADHD/TD co-morbidity is less well understood.
Objectives
To investigate the frequency of SDB and PLMS across children with ADHD, TD and ADHD/TD co-morbidity compared with healthy peers.
Aims
We asked whether and how the frequency of SDB and PLMS relates to sleep architecture.
Methods
Twenty-four children with ADHD, 21 with TD, 21 with ADHD/TD co-morbidity and 22 healthy controls underwent a two-night polysomnography supplemented by monitoring of apnea-hypopnea (AH) and PLMS events per hour of total sleep time.
Results
Compared with controls, only ADHD children displayed a significantly higher AH and PLMS indices. Yet correlation analyses showed significant and negative association between AH and PLMS indices and rapid eye movement (REM) sleep amount in all, the ADHD, the TD (Fig. 1), the co-morbid, and the control (Fig. 2) groups. No such associations with the other sleep stages were found for all the groups.
[Figure 1]
Conclusions
Our preliminary results suggest that
(1) presence of co-existing sleep-related disorders may partially explain the contradicting sleep results found so far in children with ADHD,
(2) high frequency of SDB and PLMS could be associated with REM sleep reduction regardless of psychopathology.
To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).
Design:
An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.
Setting:
Four hospitals in an academic healthcare network.
Patients:
All patients with a C. difficile order after hospital day 3.
Intervention:
Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order (“nudge”).
Results:
Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73–0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61–1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93–0.97).
Conclusion:
An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.
Background: Focal cortical dysplasias (FCDs) are congenital structural abnormalities of the brain, and represent the most common cause of medication-resistant focal epilepsy in children and adults. Recent studies have shown that somatic mutations (i.e. mutations arising in the embryo) in mTOR pathway genes underlie some FCD cases. Specific therapies targeting the mTOR pathway are available. However, testing for somatic mTOR pathway mutations in FCD tissue is not performed on a clinical basis, and the contribution of such mutations to the pathogenesis of FCD remains unknown. Aim: To investigate the feasibility of screening for somatic mutations in resected FCD tissue and determine the proportion and spatial distribution of FCDs which are due to low-level somatic mTOR pathway mutations. Methods: We performed ultra-deep sequencing of 13 mTOR pathway genes using a custom HaloPlexHS target enrichment kit (Agilent Technologies) in 16 resected histologically-confirmed FCD specimens. Results: We identified causal variants in 62.5% (10/16) of patients at an alternate allele frequency of 0.75–33.7%. The spatial mutation frequency correlated with the FCD lesion’s size and severity. Conclusions: Screening FCD tissue using a custom panel results in a high yield, and should be considered clinically given the important potential implications regarding surgical resection, medical management and genetic counselling.
To develop a risk score to predict probability of bloodstream infections (BSIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE).
DESIGN
Retrospective case-control study.
SETTING
Two large community hospitals.
PATIENTS
Hospitalized adults with Enterobacteriaceae BSI between January 1, 2010, and June 30, 2015.
METHODS
Multivariate logistic regression was used to identify independent risk factors for ESBLE BSI. Point allocation in extended-spectrum β-lactamase prediction score (ESBL-PS) was based on regression coefficients.
RESULTS
Among 910 patients with Enterobacteriaceae BSI, 42 (4.6%) had ESBLE bloodstream isolates. Most ESBLE BSIs were community onset (33 of 42; 79%), and 25 (60%) were due to Escherichia coli. Independent risk factors for ESBLE BSI and point allocation in ESBL-PS included outpatient procedures within 1 month (adjusted odds ratio [aOR], 8.7; 95% confidence interval [CI], 3.1–22.9; 1 point), prior infections or colonization with ESBLE within 12 months (aOR, 26.8; 95% CI, 7.0–108.2; 4 points), and number of prior courses of β-lactams and/or fluoroquinolones used within 3 months of BSI: 1 course (aOR, 6.3; 95% CI, 2.7–14.7; 1 point), ≥2 courses (aOR, 22.0; 95% CI, 8.6–57.1; 3 points). The area under the receiver operating characteristic curve for the ESBL-PS model was 0.86. Patients with ESBL-PSs of 0, 1, 3, and 4 had estimated probabilities of ESBLE BSI of 0.7%, 5%, 24%, and 44%, respectively. Using ESBL-PS ≥3 to indicate high risk provided a negative predictive value of 97%.
CONCLUSIONS
ESBL-PS estimated patient-specific risk of ESBLE BSI with high discrimination. Incorporation of ESBL-PS with acute severity of illness may improve adequacy of empirical antimicrobial therapy and reduce carbapenem utilization.
Direct numerical simulations of flows in cylinders subjected to both rapid rotation and axial precession are presented and analysed in the context of a stability theory based on the triadic resonance of Kelvin modes. For a case that was chosen to provide a finely tuned resonant instability with a small nutation angle, the simulations are in good agreement with the theory and previous experiments in terms of mode shapes and dynamics, including long-time-scale regularization of the flow and recurrent collapses. Cases not tuned to the most unstable triad, but with the nutation angle still small, are also in quite good agreement with theoretical predictions, showing that the presence of viscosity makes the physics of the triadic-resonance model robust to detuning. Finally, for a case with
$45^{\circ }$
nutation angle for which it has been suggested that resonance does not occur, the simulations show that a slowly growing triadic resonance predicted by theory is in fact observed if sufficient evolution time is allowed.
We succeeded in photovoltaic power generation of p-i-n solar cells utilizing epitaxial ZnInON film with a wide band gap of 3.1 eV as the intrinsic layer, suitable for a top cell of tandem solar cells. The solar cell shows a high open circuit voltage (Voc) of 1.68 V under solar simulator light irradiation of 3.2 mW/cm2. The solar cell performance becomes worse under 100 mW/cm2, which is mainly attributed to the leakage current caused by crystal defects and grain boundaries. X-ray diffraction analysis reveals that the ZnInON film has rather large tilt and twist angles and a high dislocation density of 7.62×1010 cm-2. Such low crystallinity is a bottleneck for high performance of the solar cells. Our results demonstrate a potential of epitaxial ZnInON films as an intrinsic layer of wide band gap p-i-n solar cells with a high Voc.
Effects of surface morphology of buffer layers on ZnO/sapphire heteroepitaxial growth have been investigated by means of “nitrogen mediated crystallization (NMC) method”, where the crystal nucleation and growth are controlled by absorbed nitrogen atoms. We found a strong correlation between the height distribution profile of NMC-ZnO buffer layers and the crystal quality of ZnO films. On the buffer layer with a sharp peak in height distribution, a single-crystalline ZnO film with atomically-flat surface was grown. Our results indicate that homogeneous and high-density nucleation at the initial growth stages is critical in heteroepitaxy of ZnO on lattice mismatched substrates.
AlGaN-based SQW heterostructures grown by plasma-assisted molecular beam epitaxy on c-Al2O3 substrates have been studied with high resolution transmission electron microscopy (HR TEM), photoluminescence spectroscopy and x-ray diffraction. The high-temperature (780°C) synthesis of the AlN buffer layer nucleated on c-Al2O3 by a migration enhanced epitaxy and including several ultra-thin GaN interlayers grown under moderate N-rich conditions was shown to be the optimum approach for lowering the threading dislocations density down to 108-109 cm-2. HR TEM study has confirmed the fine structure of single quantum wells (SQW) formed by a sub-monolayer digital alloying technique and revealed different kinds of compositional inhomogeneities in the AlxGa1-xN barrier layers of the heterostructures, including the formation of Al-rich barriers induced by the temperature-modulated epitaxy and the spontaneous compositional disordering along the growth axis for x=0.6-0.7. The influence of these phenomena on the parameters of the mid-UV stimulated emission observed in the SQW structures has been studied as well.
A dislocation-{101̅2} twin boundary (TB) interaction model was proposed and introduced into discrete dislocation dynamics simulations to study the mechanical behavior of micro-twinned Mg. Strong strain hardening was captured by current simulations, which is associated with the strong TB’s barrier effect. In addition, twin size effects with small TB spacing leading to a strong yield stress, were observed to be orientation dependent. Basal slip orientation produces a strong size effect, while prismatic slip does a weak one.
A review is presented of Synchrotron X-ray Topography and KOH etching studies carried out on n type 4H-SiC offcut substrates before and after homo-epitaxial growth to study defect replication and strain relaxation processes and identify the nucleation sources of both interfacial dislocations (IDs) and half-loop arrays (HLAs) which are known to have a deleterious effect on device performance. We show that these types of defects can nucleate during epilayer growth from: (1) short segments of edge oriented basal plane dislocations (BPDs) in the substrate which are drawn by glide into the epilayer; and (2) segments of half loops of BPD that are attached to the substrate surface prior to growth which also glide into the epilayer. It is shown that the initial motion of the short edge oriented BPD segments that are drawn from the substrate into the epilayer is caused by thermal stress resulting from radial temperature gradients experienced by the wafer whilst in the epi-chamber. This same stress also causes the initial glide of the surface half-loop into the epilayer and through the advancing epilayer surface. These mobile BPD segments provide screw oriented segments that pierce the advancing epilayer surface that initially replicate as the crystal grows. Once critical thickness is reached, according to the Mathews-Blakeslee model [1], these screw segments glide sideways under the action of the mismatch stress leaving IDs and HLAs in their wake. The origin of the mismatch stress is shown to be associated with lattice parameter differences at the growth temperature, arising from the differences in doping concentration between substrate and epilayer.
The indentation hardness and yield strength of various wurtzite-structured semiconductors, such as AlN, GaN, InN, and ZnO, were summarized together with those of 6H-SiC. From analysis of the data, the activation energy for motion of an individual dislocation was deduced to be 2–2.7 and 0.7–1.2 eV in GaN and ZnO, respectively, and the evaluated activation energy for dislocation motion showed a dependence on the dislocation energy in the minimum length. The results were evaluated in terms of homology and the basic mechanism of the dislocation process. Dislocation motion is thought to be primarily controlled by the atomic bonding character of the semiconductors.
In order to understand enhanced mechanical properties of magnesium-yttrium (Mg-Y) alloys, applied stresses which were required to operate independent plastic deformation mechanisms on various stress axes were evaluated. Moreover, for this analysis, mechanical tests including newly-established testing method “pure-shear test” were conducted to evaluate Critical Resolved Shear Stresses (CRSSes) for various plastic deformation mechanisms of Mg-Y solid solution alloy single crystals with various Y concentration. Relatively higher solid solution strengthening of dominant plastic deformation mechanisms such as basal slip and extension twin at room temperature, results in increase in the activation of non-basal slip system. By a simple analysis based on von-Mises criterion with experimental CRSS values, it is revealed that enhanced mechanical properties of Mg-Y alloys might be attributed to the decrease of difference in the activity of plastic deformation mechanisms by Y addition.
The results of molecular dynamics (MD) simulations of dislocation glide in GaN using a Tersoff potential are presented. The simulation methodology involves applying a constant shear stress to a single crystal system containing an individual dislocation, with multiple slip systems considered. Upon reaching a steady state, the dislocation velocity as a function of applied stress and temperature are determined. Edge dislocations with a-type Burgers vectors in the basal, prismatic and pyramidal planes have been analyzed over the temperature range of 300-1300K. The results from simulations of c-type edge dislocations at 1300 K are also presented.
Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Incl8-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer.
Objective.
Identify the prevalence of VRSA precursor organisms.
Design.
Prospective cohort with embedded case-control study.
Participants.
Southeastern Michigan adults with chronic lower-extremity wounds.
Methods.
Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Incl8-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis).
Results.
Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Incl8-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses.
Conclusions.
Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.