Integrated waveguide and nanostructured sensor platform for surface-enhanced Raman spectroscopy

Limitations of current sensors include large dimensions, sometimes limited sensitivity and inherent single-parameter measurement capability. Surface-enhanced Raman spectroscopy can be utilized for environment and pharmaceutical applications with the intensity of the Raman scattering enhanced by a factor of 106. By fabricating and characterizing an integrated optical waveguide beneath a nanostructured precious metal coated surface a new surface-enhanced Raman spectroscopy sensing arrangement can be achieved. Nanostructured sensors can provide both multiparameter and high-resolution sensing. Using the slab waveguide core to interrogate the nanostructures at the base allows for the emission to reach discrete sensing areas effectively and should provide ideal parameters for maximum Raman interactions. Thin slab waveguide films of silicon oxynitride were etched and gold coated to create localized nanostructured sensing areas of various pitch, diameter, and shape. These were interrogated using a Ti:Sapphire laser tuned to 785-nm end coupled into the slab waveguide. The nanostructured sensors vertically projected a Raman signal, which was used to actively detect a thin layer of benzyl mercaptan attached to the sensors

Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review

Objectives: The objective of this study was to conduct a systematic review of the literature to address the following clinical questions: In adult patients with acute and subacute complete or incomplete traumatic SCI, (1) does the time interval between injury and commencing rehabilitation affect outcome?; (2) what is the comparative effectiveness of different rehabilitation strategies, including different intensities and durations of treatment?; (3) are there patient or injury characteristics that affect the efficacy of rehabilitation?; and (4) what is the cost-effectiveness of various rehabilitation strategies? Methods: A systematic search was conducted for literature published through March 31, 2015 that evaluated rehabilitation strategies in adults with acute or subacute traumatic SCI at any level. Studies were critically appraised individually and the overall strength of evidence was evaluated using methods proposed by the GRADE (Grades of Recommendation Assessment, Development and Evaluation) working group. Results: The search strategy yielded 384 articles, 19 of which met our inclusion criteria. Based on our results, there was no difference between body weight–supported treadmill training and conventional rehabilitation with respect to improvements in Functional Independence Measure (FIM) Locomotor score, Lower Extremity Motor Scores, the distance walked in 6 minutes or gait velocity over 15.2 m. Functional electrical therapy resulted in slightly better FIM Motor, FIM Self-Care, and Spinal Cord Independence Measure Self-Care subscores compared with conventional occupational therapy. Comparisons using the Toronto Rehabilitation Institute Hand Function Test demonstrated no differences between groups in 7 of 9 domains. There were no clinically important differences in Maximal Lean Test, Maximal Sidewards Reach Test, T-shirt Test, or the Canadian Occupational Performance Measure between unsupported sitting training and standard in-patient rehabilitation. Conclusion: The current evidence base for rehabilitation following acute and subacute spinal cord injury is limited. Methodological challenges have contributed to this and further research is still needed. © 2017, © The Author(s) 2017

Circulation characteristics of a monsoon depression during BOBMEX-99 using high-resolution analysis

The skill and efficiency of a numerical model mostly varies with the quality of initial values, accuracy on parameterization of physical processes and horizontal and vertical resolution of the model. Commonly used low-resolution reanalyses are hardly able to capture the prominent features associated with organized convective processes in a monsoon depression. The objective is to prepare improved high-resolution analysis by the use of MM5 modelling system developed by the Pennsylvania State University/National Center for Atmospheric Research (PSU/NCAR). It requires the objective comparison of high and low-resolution analysis datasets in assessing the specific convective features of a monsoon depression. For this purpose, reanalysis datasets of NCAR/NCEP (National Center for Atmospheric Research/National Centers for Environmental Prediction) at a horizontal resolution of 2.5° (latitude/longitude) have been used as first guess in the objective analysis scheme. The additional asynoptic datasets obtained during BOBMEX-99 are utilized within the assimilation process. Cloud Motion Wind (CMW) data of METEOSAT satellite and SSM/I surface wind data are included for the improvement of derived analysis. The multiquadric (MQD) interpolation technique is selected and applied for meteorological objective analysis at a horizontal resolution of 30 km. After a successful inclusion of additional data, the resulting reanalysis is able to produce the structure of convective organization as well as prominent synoptic features associated with monsoon depression. Comparison and error verifications have been done with the help of available upper-air station data. The objective verification reveals the efficiency of the analysis scheme

Important synoptic features during INDOEX IFP-99

INDOEX IFP-99 was undertaken as part of the international experiment in the Indian Ocean to take observations pertaining to aerosols, radiation, cloud physics and other related meteorological parameters. The important-aim of the INDOEX was to quantify radiative forcing due to natural and anthropogenic aerosols and their feedback on regional and global climate systems. Since prevailing circulation features transports aerosols, it is essential that important synoptic patterns during the expedition phase, i.e. 20 January to 10 March 1999 be examined. Based on the synoptic features it was noticed that crossequatorial flow in lower levels from western Arabian Sea to southern Indian Ocean was significantly higher than the eastern Arabian Sea. Two cyclonic storms, one in the south Bay of Bengal during 1-3 February and another in the south Indian Ocean during 4-13 March were observed. Significant changes in the cross-equatorial flow in the lower/upper tropospheric levels and ITCZ locations were noticed

Patient-Reported Side Effects of Intradetrusor Botulinum Toxin Type A for Idiopathic Overactive Bladder Syndrome

Objective: The aim of the study was a prospective assessment of patient-reported side effects in an open-label study after intradetrusor botulinum toxin injections for idiopathic overactive bladder (OAB). Patients and Methods: Botulinum toxin A injection was performed in 56 patients with idiopathic OAB. Patients were followed up for 6 months concerning side effects and patients' satisfaction. Results: Different types of side effects were assessed such as dry mouth (19.6%), arm weakness (8.9%), eyelid weakness (8.9%), leg weakness (7.1%), torso weakness (5.4%), impaired vision (5.4%) and dysphagia (5.4%). In all cases, symptoms were mild and transient. Urological complications such as gross hematuria (17.9%), acute urinary retention (8.9%) and acute urinary tract infection (7.1%) were noticed. In all cases, acute urinary retention was transient and treated with temporary intermittent self-catheterization. There was no statistically significant correlation between dosage and observed side effects. Patients' satisfaction rate was high (71.4%). Conclusion: Intradetrusor injection of botulinum toxin was associated with a high rate of neurourological side effects. In general, side effects were transient, mild and did not require special treatment. Copyright (C) 2010 S. Karger AG, Base

The Burnout Epidemic Within A Viral Pandemic: Impact of a Wellness Initiative

Background: Anesthesiologists are at high risk of developing burnout, a condition which can lead to many deleterious effects for the physician, and far-reaching effects on their patients and hospital systems. The COVID-19 pandemic has presented new challenges that have further exacerbated the risk of burnout in anesthesiologists. It is critical to develop effective strategies to promote well-being and decrease burnout for physicians in this specialty. The purpose of this observational study was to evaluate the impact of a Physician Well-Being Initiative on distress and well-being in anesthesiologists. It was hypothesized that the wellness intervention would promote an improvement in well-being scores. Methods: The Physician Well-Being Initiative was launched in August 2019 in the Department of Anesthesiology, Pain Management and Perioperative Medicine at Henry Ford Hospital in Detroit, Michigan. The Physician Well-Being Initiative was designed to address several of the key factors that improve physician wellness, including 1) a sense of autonomy; 2) positive view of leadership; and 3) flexible schedule opportunities. To assess the impact of the Physician Well-Being Initiative on the well-being and distress scores of participating anesthesiologists, the physicians were emailed the validated Well-Being Index survey at baseline and 3, 6 and 12 months. The Well-Being Index evaluates multiple items of distress in the healthcare setting. The sample size was limited to the 54 anesthesiologists at Henry Ford Hospital. Results: Forty-four of the 54 anesthesiologists completed the baseline questionnaire. A total of 44 physicians answered the questionnaire at baseline, with more male than female physicians (35 males and 7 females) and the majority (17/44) in practice for 5-10 years. Thirty-two physicians completed the survey at 3 and 6 months, and 31 physicians at 12 months after the launch of the Physician Well-Being Initiative. Twenty-one physicians completed the questionnaire at all 4 time points. Although the COVID-19 pandemic started shortly after the 6-month surveys were submitted, results indicated that there was a 0.05 decrease in the Well-Being Index sum score for every 1-month of time (coefficient -0.05, 95% CI -0.01, -0.08, P = 0.013). This study shows that, with the wellness initiative in place, the department was able to maintain and potentially even reduce physician distress despite the concurrent onset of the pandemic. Conclusions: Following the launch of a sustained wellness initiative, this study demonstrates that physician wellness improved with time. This suggests that it takes time for a wellness initiative to have an effect on well-being and distress in anesthesiologists

Is age a barrier to chemotherapy? Rates of treatment in older patients with breast, colon or lung cancer in England in 2014: A national registry study

Background Survival from cancer in older patients is poorer in the UK than other countries with similar health systems and wealth possibly due to undertreatment and increased toxicities in this specific population. This population-based observational study describes factors affecting systemic anticancer treatment (SACT) use in older patients in England. Methods We identified patients aged ≥70 with stage II-III breast cancer, stage III colon cancer and stage IIIB-IV non-small cell lung cancer (NSCLC) diagnosed in 2014 from a dataset collected by the National Health Service in England. We used logistic regression to estimate factors affecting likelihood of receiving SACT and performed separate regression analyses for each disease, adjusting for age, gender, stage at diagnosis, pathological features, performance status, Charlson comorbidity index, ethnicity and socioeconomic group. We assessed 2-year overall survival (OS) using Kaplan-Meier method. Case mix adjusted treatment rates and workload volume were calculated at hospital level and presented using funnel plots, stratified by age groups (<70 and ≥70) to allow for assessment of variation between centres. Results 36892 patients were identified: 19879 with stage II-III breast cancer, 5292 with stage III colon cancer and 11721 with stage IIIB-IV NSCLC. Patients over 70 were less likely to receive SACT compared to those aged under 70: breast 11.7% vs 64.6%, p < 0.001; colon 37.4% vs 79%, p < 0.001; NSCLC 33.5% vs 60.2%, p < 0.001. 2-year OS for patients receiving SACT was similar for patients aged ≥70 and <70: breast 91.5% (95% CI: 89.3%-93.2%) vs 96.4% (95% CI: 95.9%-96.7%); colon 84.8% (95% CI: 82.6%-86.8%) vs 88.3% (95% CI: 86.7%-89.8%); NSCLC 16.7% (95% CI: 15.1%-18.4%) vs 19.8% (95%CI: 18.5%-21.1%). Patients receiving SACT had better OS than those untreated. SACT rates varied widely between hospitals after adjusting for case-mix across all ages. Conclusions Our study suggests that several factors affect the likelihood of receiving SACT but after adjusting for these, age remains determinant. Identifying hospitals with significantly lower SACT rates should prompt local review of multidisciplinary team practice

BOBMEX: the Bay of Bengal monsoon experiment

The first observational experiment under the Indian Climate Research Programme, called the Bay of Bengal Monsoon Experiment (BOBMEX), was carried out during July-August 1999. BOBMEX was aimed at measurements of important variables of the atmosphere, ocean, and their interface to gain deeper insight into some of the processes that govern the variability of organized convection over the bay. Simultaneous time series observations were carried out in the northern and southern Bay of Bengal from ships and moored buoys. About 80 scientists from 15 different institutions in India collaborated during BOBMEX to make observations in most-hostile conditions of the raging monsoon. In this paper, the objectives and the design of BOBMEX are described and some initial results presented. During the BOBMEX field phase there were several active spells of convection over the bay, separated by weak spells. Observation with high-resolution radiosondes, launched for the first time over the northern bay, showed that the magnitudes of the convective available potential energy (CAPE) and the convective inhibition energy were comparable to those for the atmosphere over the west Pacific warm pool. CAPE decreased by 2-3 kJ kg-1 following convection, and recovered in a time period of 1-2 days. The surface wind speed was generally higher than 8 m s-1. The thermohaline structure as well as its time evolution during the BOBMEX field phase were found to be different in the northern bay than in the southern bay. Over both the regions, the SST decreased during rain events and increased in cloud-free conditions. Over the season as a whole, the upper-layer salinity decreased for the north bay and increased for the south bay. The variation in SST during 1999 was found to be of smaller amplitude than in 1998. Further analysis of the surface fluxes and currents is expected to give insight into the nature of coupling

Tumour stage, treatment, and survival of women with high-grade serous tubo-ovarian cancer in UKCTOCS: an exploratory analysis of a randomised controlled trial.

BACKGROUND: In UKCTOCS, there was a decrease in the diagnosis of advanced stage tubo-ovarian cancer but no reduction in deaths in the multimodal screening group compared with the no screening group. Therefore, we did exploratory analyses of patients with high-grade serous ovarian cancer to understand the reason for the discrepancy. METHODS: UKCTOCS was a 13-centre randomised controlled trial of screening postmenopausal women from the general population, aged 50-74 years, with intact ovaries. The trial management system randomly allocated (2:1:1) eligible participants (recruited from April 17, 2001, to Sept 29, 2005) in blocks of 32 using computer generated random numbers to no screening or annual screening (multimodal screening or ultrasound screening) until Dec 31, 2011. Follow-up was through national registries until June 30, 2020. An outcome review committee, masked to randomisation group, adjudicated on ovarian cancer diagnosis, histotype, stage, and cause of death. In this study, analyses were intention-to-screen comparisons of women with high-grade serous cancer at censorship (Dec 31, 2014) in multimodal screening versus no screening, using descriptive statistics for stage and treatment endpoints, and the Versatile test for survival from randomisation. This trial is registered with the ISRCTN Registry, 22488978, and ClinicalTrials.gov, NCT00058032. FINDINGS: 202 562 eligible women were recruited (50 625 multimodal screening; 50 623 ultrasound screening; 101 314 no screening). 259 (0·5%) of 50 625 participants in the multimodal screening group and 520 (0·5%) of 101 314 in the no screening group were diagnosed with high-grade serous cancer. In the multimodal screening group compared with the no screening group, fewer were diagnosed with advanced stage disease (195 [75%] of 259 vs 446 [86%] of 520; p=0·0003), more had primary surgery (158 [61%] vs 219 [42%]; p<0·0001), more had zero residual disease following debulking surgery (119 [46%] vs 157 [30%]; p<0·0001), and more received treatment including both surgery and chemotherapy (192 [74%] vs 331 [64%]; p=0·0032). There was no difference in the first-line combination chemotherapy rate (142 [55%] vs 293 [56%]; p=0·69). Median follow-up from randomisation of 779 women with high-grade serous cancer in the multimodal and no screening groups was 9·51 years (IQR 6·04-13·00). At censorship (June 30, 2020), survival from randomisation was longer in women with high-grade serous cancer in the multimodal screening group than in the no screening group with absolute difference in survival of 6·9% (95% CI 0·4-13·0; p=0·042) at 18 years (21% [95% CI 15·6-26·2] vs 14% [95% CI 10·5-17·4]). INTERPRETATION: To our knowledge, this is the first evidence that screening can detect high-grade serous cancer earlier and lead to improved short-term treatment outcomes compared with no screening. The potential survival benefit for women with high-grade serous cancer was small, most likely due to only modest gains in early detection and treatment improvement, and tumour biology. The cumulative results of the trial suggest that surrogate endpoints for disease-specific mortality should not currently be used in screening trials for ovarian cancer. FUNDING: National Institute for Health Research, Medical Research Council, Cancer Research UK, The Eve Appeal