Endocuff Vision Reduces Inspection Time Without Decreasing Lesion Detection in a Randomized Colonoscopy Trial

Background & Aims Mucosal exposure devices improve detection of lesions during colonoscopy and have reduced examination times in uncontrolled studies. We performed a randomized trial of Endocuff Vision vs standard colonoscopy to compare differences in withdrawal time (the primary end point). We proposed that Endocuff Vision would allow complete mucosal inspection in a shorter time without impairing lesion detection. Methods Adults older than 40 years undergoing screening or surveillance colonoscopies were randomly assigned to the Endocuff group (n=101, 43.6% women) or the standard colonoscopy group (n=99; 57.6% women). One of 2 experienced endoscopists performed the colonoscopies, aiming for a thorough evaluation of the proximal sides of all haustral folds, flexures, and valves in the shortest time possible. Inspection time was measured with a stopwatch and calculated by subtracting washing, suctioning, polypectomy and biopsy times from total withdrawal time. Results There were significantly fewer women in the Endocuff arm (P = .0475) but there were no other demographic differences between groups. Mean insertion time with Endocuff was 4.0 min vs 4.4 min for standard colonoscopy (P = .14). Mean inspection time with Endocuff was 6.5 min vs 8.4 min for standard colonoscopy (P < .0001). Numbers of adenomas detected per colonoscopy (1.43 vs 1.07; P = .07), adenoma detection rate (61.4% vs 52%; P = .21), number of sessile serrated polyps per colonoscopy (0.27 vs 0.21; P = .12), and sessile serrated polyp detection rate (19.8% vs 11.1%; P = .09) were all higher with Endocuff Vision. Results did not differ significantly when we controlled for age, sex, or race. Conclusion In a randomized trial, we found inclusion of Endocuff in screening or surveillance colonoscopies to decrease examination time without reducing lesion detection

Morphological and molecular characterisation of a mixed Cryptosporidium muris/Cryptosporidium felis infection in a cat

To date Cryptosporidium muris has been identified by microscopy and genotyping in cats in two studies. We report morphological and genetic evidence of a mixed C. muris and C. felis infection in a cat and provide the first histological, immunohistochemical, in situ hybridisation and genetic confirmation of a C. muris infection in the stomach of a cat. The cat suffered persistent diarrhoea after the initial consultation, which remained unresolved, despite several medical interventions. Further studies are required to determine the range, prevalence and clinical impact of Cryptosporidium species infecting cats

Characterization of Spontaneous and Induced Puberty in Girls with Turner Syndrome

OBJECTIVE: To characterize puberty in girls with Turner syndrome (TS) and determine whether specific patient characteristics are associated with the timing of menarche. We also sought to compare spontaneous versus induced puberty in these patients. METHODS: Medical records of girls followed in our Pediatric Endocrine clinic for TS from 2007 to 2015 were reviewed. RESULTS: Fifty-three girls were included, of whom 10 (19%) achieved menarche spontaneously and 43 (81%) received hormone replacement therapy (HRT). Of girls receiving HRT, a younger age at estrogen initiation correlated with a longer time to menarche (P = .02), and a mosaic karyotype was associated with a shorter time to menarche (P = .02), whereas no relationship was seen for body mass index, estrogen regimen, or maternal age at menarche. Nineteen girls (44%) receiving HRT had bleeding on estrogen alone at a wide dose range and were more likely to be on transdermal than oral preparations (P = .01). Girls with spontaneous puberty achieved menarche at a younger age (P<.01) and were more likely to have mosaic TS (P = .02). CONCLUSION: Significant variability in the timing of menarche exists among girls with TS. However, age at pubertal induction and karyotype were significantly correlated with age at menarche in our patients. A wide range of estrogen doses is seen in girls who bleed prior to progesterone, suggesting extreme variability in estrogen sensitivity among patients with TS. Girls achieving spontaneous menarche are younger and more likely to have a mosaic karyotype than those with induced menarche. Large-scale prospective studies are needed to confirm these results

Development of a Protocol for Successful Palliative Care Consultation in Population of Patients Receiving Mechanical Circulatory Support

Background In 2014, Joint Commission recommended palliative care (PC) engagement in ventricular assist device (VAD) implantation as destination therapy. Limited information is available on established PC protocols in the mechanical circulatory support (MCS) population. Measures The goals of our PC consultation were to document advance care planning (ACP) discussions and designate a surrogate decision maker (SDM) prior to MCS implantation. A retrospective analysis compared the frequency of PC consults, ACP discussion, and SDM before and after protocol implementation. Intervention A protocol was developed to conduct interdisciplinary PC consultations for the MCS population. Outcomes The percentage of PC consults placed prior to MCS implantation increased from 11 (17.2%) pre-protocol to 56 (96.6%) post-protocol (p<0.0001), and documented SDM increased from 26 (40.6%) pre-protocol to 57 (98.3%) post protocol (p<0.0001). Conclusion Close PC/cardiology collaboration can substantially improve ACP discussions and SDM documentation in the MCS population. This multidisciplinary protocol facilitates successful PC consultations

Embedding a Carbon Nanotube across the Diameter of a Solid State Nanopore

A fabrication method for positioning and embedding a single-walled carbon nanotube (SWNT) across the diameter of a solid state nanopore is presented. Chemical vapor deposition (CVD) is used to grow SWNTs over arrays of focused ion beam (FIB) milled pores in a thin silicon nitride membrane. This typically yields at least one pore whose diameter is centrally crossed by a SWNT. The final diameter of the FIB pore is adjusted to create a nanopore of any desired diameter by atomic layer deposition, simultaneously embedding and insulating the SWNT everywhere but in the region that crosses the diameter of the final nanopore, where it remains pristine and bare. This nanotube-articulated nanopore is an important step towards the realization of a new type of detector for biomolecule sensing and electronic characterization, including DNA sequencing.Engineering and Applied SciencesMolecular and Cellular BiologyPhysic

Electronic Raman scattering in a multiband model for cuprate superconductors

Charge-charge, current-current and Raman correlation functions are derived in a consistent way using the unified response theory. The theory is based on the improved description of the conduction electron coupling to the external electromagnetic fields, distinguishing further the direct and indirect (assisted) scattering on the quasi-static disorder. The two scattering channels are distinguished in terms of the energy and momentum conservation laws. The theory is illustrated on the Emery three-band model for the normal state of the underdoped high-$T_c$ cuprates which includes the incoherent electron scattering on the disorder associated with the quasi-static fluctuations around the static antiferromagnetic (AF) ordering. It is shown, for the first time consistently, that the incoherent indirect processes dominate the low-frequency part of the Raman spectra, while the long-range screening which is dynamic removes the long-range forces in the $A_{1g}$ channel. In the mid-infrared frequency range the coherent AF processes are dominant. In contrast to the nonresonant $B_{1g}$ response, which is large by itself, the resonant interband transitions enhance both the $A_{1g}$ and $B_{1g}$ Raman spectra to comparable values, in good agreement with experimental observation. It is further argued that the AF correlations give rise to the mid-infrared peak in the $B_{1g}$ Raman spectrum, accompanied by a similar peak in the optical conductivity. The doping behavior of these peaks is shown to be correlated with the linear doping dependence of the Hall number, as observed in all underdoped high-$T_c$ compounds.Comment: 18 pages, 14 figures; to appear in Phys. Rev.

Influence of local fullerene orientation on the electronic properties of A3C60 compounds

We have investigated sodium containing fullerene superconductors Na2AC60, A = Cs, Rb, and K, by Na-23 nuclear magnetic resonance (NMR) spectroscopy at 7.5 T in the temperature range of 10 to 400 K. Despite the structural differences from the Rb3C60 class of fullerene superconductors, in these compounds the NMR line of the tetrahedrally coordinated alkali nuclei also splits into two lines (T and T') at low temperature. In Na2CsC60 the splitting occurs at 170 K; in the quenched cubic phase of Na2RbC60 and Na2KC60 we observe split lines at 80 K. Detailed investigations of the spectrum, spin-spin and spin-lattice relaxation as well as spin-echo double resonance (SEDOR) in Na2CsC60 we show that these two different tetrahedral sites are mixed on a microscopic scale. The T and T' sites differ in the orientation of first-neighbor C60 molecules. We present evidence that the orientations of neighboring molecules are uncorrelated. Thermally activated molecular reorientations cause an exchange between the T and T' sites and motional narrowing at high temperature. We infer the same activation energy, 3300 K, in the temperature range 125 to 300 K. The spin lattice relaxation rate is the same for T and T' down to 125 K but different below. Both the spin-lattice relaxation rate and Knight shift are strongly temperature dependent in the whole range investigated. We interpret this temperature variation by the effect of phonon excitations involving the rigid librational motion of the C60 molecules. By extending the understanding of the structure and molecular dynamics of C60 superconductors, these results may help in clarifying the effects of the structure on the superconducting properties.Comment: 13 pages, 10 figures, submitted to PR

Commercials, careers and culture: travelling salesmen in Britain 1890s-1930s

Within the lower middle-class, British commercial travellers established a strong fraternal culture before 1914. This article examines their interwar experiences in terms of income, careers, and associational culture. It demonstrates how internal labour markets operated, identifies the ways in which commercial travellers interpreted their role, and explores their social and political attitudes

Diabetes-related quality of life and the demands and burdens of diabetes care among emerging adults with type 1 diabetes in the year after high school graduation

The roles of glycemic control, diabetes management, diabetes care responsibility, living independently of parents, and time since high school graduation in predicting diabetes-related quality of life (DQOL) were examined in 184 emerging adults with type 1 diabetes. Data were collected at graduation and 1 year later. Analyses controlling for selected covariates were completed using generalized linear mixed models. Better diabetes management was associated with more positive responses on all four dimensions of DQOL. Impact and worry of DQOL were greater in the presence of depressive symptoms, and life satisfaction was lower. DQOL life satisfaction was lower in those living independently of parents. Young women reported poorer diabetes-related health status than did young men. Time since graduation was not linked to DQOL. Further research is needed on ways to improve DQOL in conjunction with diabetes management and on ways that families can support DQOL when youth live independently

The polymer phase of the TDAE-C60_{60} organic ferromagnet

The high-pressure Electron Spin Resonance (ESR) measurements were preformed on TDAE-C$_{60}$ single crystals and stability of the polymeric phase was established in the $P - T$ parameter space. At 7 kbar the system undergoes a ferromagnetic to paramagnetic phase transition due to the pressure-induced polymerization. The polymeric phase remains stable after the pressure release. The depolymerization of the pressure-induced phase was observed at the temperature of 520 K. Below room temperature, the polymeric phase behaves as a simple Curie-type insulator with one unpaired electron spin per chemical formula. The TDAE$^+$ donor-related unpaired electron spins, formerly ESR-silent, become active above the temperature of 320 K and the Curie-Weiss behavior is re-established.Comment: Submitted to Phys. Rev.