Hot-carrier-induced deep-level defects from gated-diode measurements on MOSFETs

The reverse-bias current in the gated-diode configuration of hot-carrier degraded MOS devices was measured. It is shown that interface defects created by the degradation contribute predominantly to the generation current. The spatial distribution of the deep-level defects was obtained by means of device simulation

Non-ketonic hyperglycemia presenting with acute hemichorea and ballism

Received: October 8, 2017 Accepted: May 10, 2018 Published: August 17, 2018Financial support: Author declares that no financial assistance was taken from any source.Potential conflicts of interest: Author declares no conflicts of interest.Non-ketotic hyperglycemia is a complication of poorly controlled diabetes mellitus. Rarely, it can present like an acute neurological syndrome with unilateral choreiform and ballistic movements. Such a presentation usually raises the suspicion of a cerebrovascular event and prompts more workup. Moreover, the neuroimaging in this condition also suggests a variety of potential possibilities. Identification of this rare presentation of non-ketotic hyperglycemia helps with the appropriate management and avoid unnecessary investigations. In this case report, we report the case of an elderly woman who presented with hemichorea-ballism due to non-ketotic hyperglycemia and discuss the literature on this presentation. We also highlighted the differential diagnosis based on neuroimaging.Pradeep C. Bollu MD (1) (Department of Neurology, University of Missouri, Columbia, Missouri)Includes bibliographical reference

Safety of Needle Electromyography in Critically Ill Patients

Introduction: To evaluate the safety of needle electromyography (EMG) in critically ill intensive care unit (ICU) patients who are on anticoagulants and have comorbidities that increase the risk of bleeding and infections. Methods: We conducted a retrospective chart review of critically ill patients who underwent needle EMG studies. The most common complications followed by needle EMG were reviewed and classified based upon common terminology criteria for adverse events (CTAC) criteria. Descriptive statistics were reported using the frequencies and percentages for categorical variables. The mean and interquartile range is used for continuous variables. All analyses were conducted using the Statistical Package for the Social Sciences (IBM SPSS Statistic Version 21, IMB Inc., Chicago, IL. Results: Twenty-nine patients were included. 17 (58.6%) were males with a mean age of 60.8 +/- 16.7 years.  The mean PT, PTT, and INR were 15.2 sec, 36.5 seconds, and 1.13, respectively. Fourteen (48.2%) patients in this cohort were treated with low molecular weight heparin (LMWH), and an additional 8 (27.5%) patients were administered subcutaneous (SC) heparin for deep vein thrombosis prophylaxis. Therapeutic heparin was being used in 3 (10.3%) patients and sequential compression devices (SCDs) in 4 (13.7%) patients. A total of 228 muscles were tested. Among them, 38 (16.6%) were deep muscles. There were no major bleeding complications at the time of the procedure and for the next seven days in any of the patients, including those with multiple medical comorbidities. All our patients met the grade 1 scale in the severity of adverse events criteria proposed by CTCAE. Conclusion: Needle EMG is safe in critically ill ICU patients on anticoagulants and multiple comorbidities including those that increase the risk of bleeding and infection

Acute esotropia in the setting of heroin withdrawal

Acute onset of concomitant esotropia presenting with diplopia can be seen in the setting of heroin withdrawal. We report a case of acute esotropia in a young white male during heroin withdrawal. A sudden onset of eye deviation is usually considered an ominous sign and patients are subjected to a multitude of diagnostic tests and investigations. Acute esotropia in the setting of heroin withdrawal is typically self-limiting. This case presentation can increase the awareness among physicians for a timely diagnosis, and prevent unnecessary diagnostic testing and further consultations.Includes bibliographical reference

False negative home sleep apnea testing - an important concept to prevent misdiagnosis in patients with underlying sleep apnea

Obstructive Sleep Apnea (OSA) syndrome is characterized by repetitive reduction or cessation of airflow due to partial or complete obstruction of the airway leading to hypoxemia, arousals from sleep and fragmented sleep. It affects 5% of adult men and 2% of women in western countries and is associated with comorbidities such as cardiovascular and cerebrovascular diseases and several neurobehavioral morbidities. The current gold standard for a definitive diagnosis of OSA is an overnight Polysomnography (PSG). The overnight polysomnogram performed in a sleep center will give the comprehensive report of that includes the number of apneas, hypopneas and respiratory effort related arousals (RERAs). The total number of apneas and hypopneas per hour of sleep is called Apnea Hypopnea Index (AHI) while the total number of apneas, hypopneas and RERAs per hour of sleep is called 'Respiratory Disturbance Index' -RDI. Sleep Apnea is diagnosed if the RDI is 5 or more per hour of sleep. Home Sleep Apnea Testing (HSAT) has become an important tool in identifying high risk population. As the name suggests, the study is done while the patients sleep in their homes. One of the limitations of the study is the lack of Electroencephalographic (EEG) data. This prevents the inclusion of RERAs in the diagnosis of Sleep Apnea. The results of this preliminary analysis serves as the foundation to elucidate whether subtle changes in breathing patterns recorded during a sleep study are reflected in changes in cortical activity.Anudeep Yelam (1); Ross Taylor (2); Pradeep C. Bollu, M.D. (1) ; (1) M2 - University of Missouri SOM, (2) Department of Neurology - University of Missouri Hospital and Clinic

Acute esophageal necrosis masquerading acute coronary syndrome

Acute esophageal necrosis (AEN) also known as “black esophagus” or “acute necrotizing esophagus” is a rare entity characterized by striking endoscopic findings of circumferential black coloring of the esophagus. AEN most frequently seen in the distal esophagus and can extend proximally along the entire esophagus. Characteristically, the circumferential black mucosa stops abruptly at the EGJ. AEN tends to present as acute upper gastrointestinal bleeding, though other symptoms including dysphagia and epigastric pain have been described. The etiology of AEN is multifactorial including a combination of ischemic insult, mucosal barrier defect, and a backflow injury of gastric secretions. Described is a case of AEN in a patient with history of uncontrolled diabetes who presented with an atypical chest pain mimicking acute coronary syndrome with negative subsequent cardiovascular workup

The effect of pre-cure bracket movement on shear bond strength during placement of orthodontic brackets, an in vitro study

Background: The purpose of this study was to determine the influence of linear and rotational pre-cure bracket displacement during the bonding procedure on shear bond strength (SBS) of orthodontic brackets. Material and Methods: Stainless steel orthodontic premolar brackets were bonded to the buccal surfaces of 50 human pre-molars with a conventional two-step bonding protocol. Extracted human pre-molars were divided into 5 groups (n=10/group). In the Control Group, the brackets were bonded with no pre-cure bracket displacement or rotation. The Rotation Group was bonded with 45 degrees of pre-cure rotation. The Displacement Group was bonded with 2mm pre-cure linear displacement. The Rotation-Displacement Group was bonded with pre-cure movements of 45º counter-clockwise rotation and 2mm displacement. The Slippage Group was bonded with 2mm each of mesial and distal pre-cure linear displacement. Photo-activation was carried out on the lateral sides of the bracket. Shear debonding force was measured, 24 hours after initial bonding, with an Instron universal testing machine using a knife-edged chisel. Data was analyzed using one-way ANOVA test. Adhesive Remnant Index (ARI) was scored under 15x magnification. The ARI data was analyzed using the Chi-square test ( p -value < 0.05). Results: No statistically significant differences were detected among the control and experimental groups ( p = 0.331). The rotation and displacement group showed the highest mean SBS than all other groups. Mean SBS for all groups were above the clinically acceptable range. No statistically significant differences were detected in ARI scores among groups ( p = 0.071). Conclusions: Linear and rotational pre-cure bracket displacements do not appear to effect the shear bond strength of orthodontic brackets

Comparative evaluation of orthodontic bracket base shapes on shear bond strength and adhesive remnant index : an in vitro study

The objective of this study was to evaluate the effect of orthodontic bracket base shape on shear bond strength and adhesive remnant index. In this in vitro study using 140 bovine incisors, shear bond strength (SBS) of brackets with different base shapes (rectangle, flower, round, heart, diamond, star, and football) were measured with an Instron testing machine and tested until bond failure. Adhesive Remnant Index (ARI) scoring was evaluated after debonding to evaluate the location of bond failure. Descriptive and one-way ANOVA post-hoc Tukey statistical analyses were performed with a statistical significance set at p?0.05. Statistically significant difference in mean SBS in Newtons was observed for multiple base shapes (p<0.05). The highest mean SBS (N ± SD) was observed in football and flower base shapes (73.83 N ± 53.46; 65.82 N ± 37.89 respectively); the lowest mean was observed with diamond and heart shapes (30.51 N ± 11.73; 33.28 N ± 16.89 respectively). When reported in Megaspascals, statistically significant difference was observed for rectangle base shape (3.54 MPa ± 2.69) when compared to all other base shapes. Bracket base shape has an effect on SBS. Higher SBS (N) for rectangle, flower, and football base shape indicates even stress distributions throughout the bracket base. Base shape with a pronounced converging tip over the axial plane may contribute to the reduction in SBS due to increased peak stress concentration resulting in bond failure

The effect of orthodontic bracket pad shape on shear bond strength, an in vitro study on human enamel

To evaluate the effect of bracket pad shape on shear bond strength (SBS) of orthodontic brackets bonded to human enamel. One hundred and five extracted human maxillary permanent molars were divided into 7 groups of 15 specimens per group (n=15). Each group of teeth was bonded with 6 different shaped WildSmiles® brackets (Star, Heart, Soccer ball, Football, Flower, and Diamond) and GAC® rectangle shaped brackets. Shear debonding force was measured with an Instron universal testing machine using a knife-edged chisel 24 hours after initial bonding. Descriptive statistics (mean, standard deviation, and range) for each bracket pad shape was calculated. Analysis of variance (ANOVA) using SPSS software version 24.0 was performed with P-value set at 0.05. Post-Hoc Tukey analysis was used to analyze differences among groups. Differences in Adhesive Remnant Index (ARI) scores among groups were analyzed using Chi-square test. Debonding force values (N ± SD) ranged from 205.51 ± 49.12 (Star) and 275.96 ± 69.05 (Soccer). SBS values (MPa ± SD) ranged from 13.34 ± 3.18 (Star) and 17.77 ± 6.94 (Rectangle). Even though intergroup comparison of SBS in Newtons revealed statistical significance (p = 0.014) between Star-Soccer and Star-Football group, it does not have any clinical significance since ranges of SBS of all groups are clinically acceptable. Analysis of ARI scores showed no significant differences in mode of bond failure among groups (P = 0.82). Orthodontic bracket pad shape has no effect on SBS and does not affect the mode of fracture pattern

Leadership in a Private Nephrology Practice: Autonomy Is More Than a Dream!

Private practice is entering an era of diminishing reimbursement and increasing overhead associated with federally mandated payment reforms resulting in a need to move from the traditional fee-for-service to a value-based model, changes that place financial and organizational strain on nephrology practices. In addition, the changing geopolitical scene is one of mergers and consolidation of health care networks, which in turn are developing their own insurance plans or partnering with commercial payers. The new landscape will require the leadership of a private nephrology practice to vigilantly monitor and adapt to these changes for success. Our leaders must be mindful of the impact of these changes to foster the successful growth of an autonomous private nephrology practice in which there is opportunity for personal and professional growth of its members in their quest to provide quality and safe patient care