Quantum Nature of Charge Transport in Inkjet-Printed Graphene Revealed in High Magnetic Fields up to 60T.

Inkjet-printing of graphene, iGr, provides an alternative route for the fabrication of highly conductive and flexible graphene films for use in devices. However, the contribution of quantum phenomena associated with 2D single layer graphene, SLG, to the charge transport in iGr is yet to be explored. Here, the first magneto-transport study of iGr in high magnetic fields up to 60 T is presented. The observed quantum phenomena, such as weak localization and negative magnetoresistance, are strongly affected by the thickness of the iGr film and can be explained by a combination of intra- and inter-flake classical and quantum charge transport. The quantum nature of carrier transport in iGr is revealed using temperature, electric field, and magnetic field dependences of the iGr conductivity. These results are relevant for the exploitation of inkjet deposition of graphene, which is of particular interest for additive manufacturing and 3D printing of flexible and wearable electronics. It is shown that printed nanostructures enable ensemble averaging of quantum interference phenomena within a single device, thereby facilitating comparison between experiment and underlying statistical models of electron transport.

[What place for ethics in psychiatry?] / Quelle place pour l'éthique en psychiatrie ?

At a time when healthcare establishments are facing sensitive financial and institutional challenges, how can ethics be given a place in psychiatry? In society, ethical debates focus on surrogate motherhood, active euthanasia or assisted suicide, and embryo research. In psychiatry, the question often crystallizes around violent incidents that are hardly representative of the daily lives of professionals and patients. Militant discourse prevails over listening to the people concerned. The law requires establishments to reflect on the ethical issues raised by the reception and medical care of patients, without specifying the boundaries. Ethics in healthcare facilities focuses on care situations - what is possible or desirable - with no single theoretical model to serve as an example to follow.

Lateral root formation and nutrients: nitrogen in the spotlight.

Lateral roots are important to forage for nutrients due to their ability to increase the uptake area of a root system. Hence, it comes as no surprise that lateral root formation is affected by nutrients or nutrient starvation, and as such contributes to the root system plasticity. Understanding the molecular mechanisms regulating root adaptation dynamics toward nutrient availability is useful to optimize plant nutrient use efficiency. There is at present a profound, though still evolving, knowledge on lateral root pathways. Here, we aimed to review the intersection with nutrient signaling pathways to give an update on the regulation of lateral root development by nutrients, with a particular focus on nitrogen. Remarkably, it is for most nutrients not clear how lateral root formation is controlled. Only for nitrogen, one of the most dominant nutrients in the control of lateral root formation, the crosstalk with multiple key signals determining lateral root development is clearly shown. In this update, we first present a general overview of the current knowledge of how nutrients affect lateral root formation, followed by a deeper discussion on how nitrogen signaling pathways act on different lateral root-mediating mechanisms for which multiple recent studies yield insights.

Predictors of methacholine challenge testing results in subjects without airflow obstruction.

OBJECTIVE: Methacholine challenge testing (MCT) is considered when asthma remains clinically suspected despite normal spirometry. Few studies have attempted to determine the predictive factors of MCT results. We aimed to establish which demographic data, clinical symptoms, pulmonary function testing results, and laboratory values were associated with abnormal MCT (provocation concentration causing a 20% decrease in FEV1 (PC20) ≤ 16 mg/mL) in subjects without airflow obstruction on spirometry. METHODS: All patients who completed MCT at Montfort Hospital between January 1st, 2016 and December 31st, 2018 were identified. Subjects with a reduced FEV1/FVC ratio were excluded. We used Pearson's chi-squared test and point-biserial correlation method to determine which variables had a significant relationship (p < 0.05) with MCT results. RESULTS: 23.3% of patients who underwent MCT had airflow limitation. In the 1126 subjects with a normal FEV1/FVC ratio, PC20 ≤ 16 mg/mL was found in 13.0%. Younger age, female gender, body mass index ≥ 40, and reported wheezing were factors associated with increased probability of airway hyper responsiveness. Lower FEV1, significant improvement of the FEV1 post-bronchodilator, reduced FEF25%-75%, greater FEF25%-75% reversibility, airway resistance measurements above the upper limit of normal, and increased blood eosinophil counts were predictive of abnormal MCT. CONCLUSIONS: Only 13.0% of patients referred for MCT had a PC20 ≤ 16 mg/mL when the FEV1/FVC ratio was normal, highlighting the need to further define in which individuals this test is truly warranted. Further investigation is required to develop an easy-to-use and validated prediction model in order to better understand patients' pretest probability of abnormal MCT.

Rice plants respond to ammonium stress by adopting a helical root growth pattern.

High levels of ammonium nutrition reduce plant growth and different plant species have developed distinct strategies to maximize ammonium acquisition while alleviating ammonium toxicity through modulating root growth. To date, the mechanisms underlying plant tolerance or sensitivity towards ammonium remain unclear. Rice (Oryza sativa) uses ammonium as its main N source. Here we show that ammonium supply restricts rice root elongation and induces a helical growth pattern, which is attributed to root acidification resulting from ammonium uptake. Ammonium-induced low pH triggers the asymmetric distribution of auxin in rice root tips through changes in auxin signaling, thereby inducing a helical growth response. Blocking auxin signaling completely inhibited this root response. In contrast, this root response is not activated in ammonium-treated Arabidopsis. Acidification of Arabidopsis roots leads to the protonation of indole-3-acetic acid and dampening of the intracellular auxin signaling levels that are required for maintaining root growth. Our study suggests a different mode of action by ammonium on the root pattern and auxin response machinery in rice versus Arabidopsis, and the rice-specific helical root response towards ammonium is an expression of the ability of rice to moderate auxin signaling and root growth to utilize ammonium while confronting acidic stress.

Impact of the Affordable Care Act Medicaid expansion on emergency department high utilizers with ambulatory care sensitive conditions: A cross-sectional study.

OBJECTIVES: The effect of the Affordable Care Act on emergency department (ED) high utilizers has not yet been thoroughly studied. We sought to determine the impact of changes in insurance eligibility following the 2014 Medicaid expansion on ED utilization for ambulatory care sensitive conditions (ACSC) by high ED utilizers in an urban safety net hospital. METHODS: High utilizers were defined as patients with ≥4 visits in the 6months before their most recent visit in the study period (July-December before and after Maryland's Medicaid expansion in January 2014). A differences-in-differences approach using logistic regression was used to investigate if differences between high and low utilizer cohorts changed from before and after the expansion. RESULTS: During the study period, 726 (4.1%) out of 17,795 unique patients in 2013 and 380 (2.4%) of 16,458 during the same period in 2014 were high utilizers (p-value <0.001). ACSC-associated visit predicted being a high utilizer in 2013 (OR 1.66 (95% CI [1.37, 2.01])) and 2014 (OR 1.65 (95% CI [1.27, 2.15])) but this was not different between years (OR ratio 0.99, 95% CI [0.72, 1.38], p-value 0.97). CONCLUSION: Although the proportion of high utilizers decreased significantly after Maryland's Medicaid expansion, ACSC-associated ED visits by high ED utilizers were unaffected.

Pulmonary Artery Bullet Embolism following Cardiac Gunshot Wound.

Penetrating chest trauma is common but few need surgical treatment (10-20%). The mortality of gunshot wounds of the heart is 45%, among the wounded arriving at the hospital. The suspicion of wound heart with an inlet in the heart area (limited by costal awnings down, clavicles top, and mid-clavicular line outside) and pericardial effusion remains a surgical indication. Gunshot wounds of the heart with migration of the projectile in the pulmonary artery are rare. Migration of projectile into the pulmonary artery is described most often with lesions of peripheral veins without concomitant cardiac involvement. The indication of projectile extraction is not clearly defined in the literature. Conservative management of selected cases of pulmonary artery bullet emboli may be warranted in light of the risks of extraction.

Severe Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Are There Significant Differences Between Hospitalized and Emergency Department Patients?

Rationale: Current guidelines define a severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) as an increase in symptoms requiring hospital admission or emergency department (ED) visit. Little is known about whether or not subjects requiring hospitalization and those needing only ED care have similar patient profiles and if their clinical outcomes appear comparable. Objective: The main goals of this study were to compare the demographic and clinical characteristics of patients treated for an AECOPD with an inpatient admission versus an ED visit and to review if hospital resource utilization was different between the 2 groups after discharge. Methods: Subjects treated in 2022 at Montfort Hospital for an AECOPD were reviewed. Patient demographic information was collected in addition to spirometry results and blood eosinophil counts on file. Supplemental oxygen use and medication lists were also recorded. Patients with an initial hospital admission were compared to those requiring only ED care with univariate and multivariate analyses. We also assessed if subjects were again treated for an AECOPD up to 6 months post initial discharge, and if so, the type of hospital visits (hospitalization or ED). Measurements and Main Results: A total of 135 individuals necessitated hospitalization and 79 received ED care for the treatment of an AECOPD. On univariate analysis, patients requiring an inpatient stay appeared older and were more likely to have spirometry results on file. A greater proportion of hospitalized individuals were on supplemental oxygen and prescribed at least one long-acting inhaled medication. These studied variables remained significant after multivariate logistic regression analysis. Subjects with an initial inpatient admission were also more likely to require hospitalization upon repeat presentation for a severe AECOPD. Conclusion: Given the important differences observed in both patient characteristics and hospital resource utilization, this study supports considering an AECOPD requiring inpatient admission versus an ED visit as distinct categories of events.

Impact of tubing material on stability and filling accuracy of biologic drug product.

This article is presenting completely new observations linked to Polysorbate 80 (PS80) oxidation in biologics drug product. Indeed, we observed that, in the drug product exposed to long contact time (∼ 1 h) in platinum-cured silicon tubing during the filling, the oxidation of PS80 is dramatically accelerated compared to short contact time. The phenomenon was observed in presence of iron traces (20 ppb), but not in absence of iron (< 2 ppb) or in presence of a chelator like EDTA. Electron Paramagnetic Resonance (EPR) measurements demonstrated the presence of radicals formed during the oxidation. It was deduced that platinum-cured silicon tubing is leaching some radical initiators, most probably peroxides decomposed by the iron. Alternative filling sets made of ThermoPlastic Elastomer (TPE) were investigated, both for the impact on PS80 stability and the filling performance using a peristaltic pump. The results showed that these filling sets were indeed not causing accelerated PS80 degradation but the process was not robust enough; these filling sets being too rigid for the constraints of the peristaltic pump rollers. These results show that there is no practical tubing alternative to platinum silicone cured tubing. To avoid the impact on PS80 oxidation the potential remediations presented in the article are to avoid any trace of iron or to add a chelating agent, or to discard the vials having experimented a filling stop (> 5 min).

Predictors of treatment response to pregabalin in unexplained or refractory chronic cough.

BACKGROUND: Patients with chronic cough (>8 weeks) often remain symptomatic after appropriate investigations and therapeutic trials. Prior research has shown a benefit in certain individuals from pregabalin, but clinical improvement is quite unpredictable and variable. OBJECTIVE: The main objective of this study was to identify the demographic and clinical characteristics associated with a higher likelihood of cough improvement with a trial of pregabalin therapy. METHODS: 50 consecutive patients with chronic cough were enrolled in this prospective cohort study. Subjects were prescribed pregabalin 75 mg oral qhs for 4 weeks followed by 75 mg oral bid. Leicester Cough Questionnaire (LCQ) was completed at treatment initiation and after 3 months of therapy. A comparison was performed between treatment responders (LCQ total score improvement ≥1.3) and non-responders. RESULTS: 56% of patients reported a LCQ total score improvement ≥1.3 (minimal clinically important difference). Responders to pregabalin therapy were more likely to have refractory (with underlying pulmonary disease) versus unexplained chronic cough (p = 0.01). Patients with significant improvement were also on average more symptomatic at baseline (mean LCQ total score 10.2 versus 13.0, p < 0.01). No significant relationship was identified with age, gender, body mass index, history of anxiety and/or depression, cigarette smoking history, or cough duration (p > 0.05). The unexplained chronic cough group had a strong female predominance (85.7% versus 40.9% for refractory cough, p < 0.01). CONCLUSION: This is the first study that has investigated clinical predictors of treatment response to pregabalin in chronic cough patients. Further research is needed to develop therapies for subjects who do not improve with currently available neuromodulating medications.

Tampa Scale of Kinesiophobia may underestimate task-specific fear of movement in people with and without low back pain.

Introduction: The Tampa Scale of Kinesiophobia (TSK) is commonly used to assess fear of movement (FoM) in people with low back pain (LBP). However, the TSK does not provide a task-specific measure of FoM, whereas image-based or video-based methods may do so. Objectives: To compare the magnitude of FoM when assessed using 3 methods (TSK-11, image of lifting, video of lifting) in 3 groups of people: current LBP (LBP), recovered LBP (rLBP), and asymptomatic controls (control). Methods: Fifty-one participants completed the TSK-11 and rated their FoM when viewing images and videos depicting people lifting objects. Low back pain and rLBP participants also completed the Oswestry Disability Index (ODI). Linear mixed models were used to estimate the effects of methods (TSK-11, image, video) and group (control, LBP, rLBP). Linear regression models were used to assess associations between the methods on ODI after adjusting for group. Finally, a linear mixed model was used to understand the effects of method (image, video) and load (light, heavy) on fear. Results: In all groups, viewing images (P = 0.009) and videos (P = 0.038) elicited greater FoM than that captured by the TSK-11. Only the TSK-11 was significantly associated with the ODI (P < 0.001). Finally, there was a significant main effect of load on fear (P < 0.001). Conclusion: Fear of specific movements (eg, lifting) may be better measured using task-specific measures, such as images and videos, than by task-generic questionnaires, such as the TSK-11. Being more strongly associated with the ODI, the TSK-11 still plays an important role in understanding the impact of FoM on disability.

Plastid-localized amino acid metabolism coordinates rice ammonium tolerance and nitrogen use efficiency.

Ammonium toxicity affecting plant metabolism and development is a worldwide problem impeding crop production. Remarkably, rice (Oryza sativa L.) favours ammonium as its major nitrogen source in paddy fields. We set up a forward-genetic screen to decipher the molecular mechanisms conferring rice ammonium tolerance and identified rohan showing root hypersensitivity to ammonium due to a missense mutation in an argininosuccinate lyase (ASL)-encoding gene. ASL localizes to plastids and its expression is induced by ammonium. ASL alleviates ammonium-inhibited root elongation by converting the excessive glutamine to arginine. Consequently, arginine leads to auxin accumulation in the root meristem, thereby stimulating root elongation under high ammonium. Furthermore, we identified natural variation in the ASL allele between japonica and indica subspecies explaining their different root sensitivity towards ammonium. Finally, we show that ASL expression positively correlates with root ammonium tolerance and that nitrogen use efficiency and yield can be improved through a gain-of-function approach.

Three Decades of Malignant Pleural Mesothelioma: An Academic Center Experience.

BACKGROUND: Malignant pleural mesothelioma (MPM) remains a challenging disease to manage. In the past few decades, extrapleural pneumonectomy (EPP), pemetrexed-based chemotherapy, and indwelling pleural catheters were introduced to MPM care with variable levels of efficacy and evidence. PATIENTS AND METHODS: This was a retrospective review of patients diagnosed with MPM between January 1991 and March 2019. The primary outcome was overall survival (OS). Data were examined by decade to assess trends in MPM demographics, management, and OS. A subgroup analysis was then conducted to examine the impact of EPP, pemetrexed, and indwelling pleural catheters on OS. RESULTS: The study included 337 patients; 309 patients had died at last follow-up (91.7%). Median age at diagnosis and the proportion of female patients increased from 65.8 years (interquartile range [IQR], 57.1-73.7) and 11.6% female from 1991 to 1999 to 75 years (IQR, 68.1-80.6) and 20.5% female from 2010 to 2019. Median OS was largely unchanged in the three study periods: 9.0 months (95% confidence interval [CI], 6.9-12.7) in the 1991-1999 cohort, 9.3 months (95% CI, 7.6-13.2) in the 2000-2009 cohort, and 10.1 months (95% CI, 7.9-13.6) in the 2010-2019 cohort. Controlling for a number of demographic and prognostic factors, EPP (hazard ratio [HR] = 0.50; 95% CI, 0.3-0.9; P = .02), pemetrexed-based chemotherapy (HR = 0.59; 95% CI, 0.40-0.87; P = .007), and indwelling pleural catheters (HR = 0.3; 95% CI, 0.13-0.71; P = .006) were each associated with improvements in OS. CONCLUSION: Despite the small incremental improvements in survival shown by the three interventions we examined, prognosis remains guarded for MPM patients. Better modalities of management are needed.

Low D LCO predicts all-cause hospital admissions in patients with reduced left ventricular ejection fraction or diastolic dysfunction.

A low D LCO should be valued as a predictor of all-cause hospital admissions in patients with reduced LVEF or isolated diastolic dysfunction. The severity of the impairment seen on D LCO testing also appears to affect the risk of hospitalisation. https://bit.ly/3e4r8bH.

Pulmonary nodules associated with pulmonary embolism: A rare and misleading presentation of amyloidosis.

Amyloidosis is a rare disease especially the localized form involving pulmonary parenchyma. We report the case of a 74 years old woman who presented with chest pain and dyspnoea. CT scan showed pulmonary embolism and bilateral nodules. Laboratory examinations highlighted circulating Kappa IgM. 18F-FDG PET/CT showed intense activity of the nodules. Histological investigation supported the diagnosis of nodular pulmonary amyloidosis. There were no sign of systemic amyloidosis or autoimmune disease. No treatment was initiated: the patient remains asymptomatic after one year. Localized pulmonary amyloidosis related to MGUS was the most likely diagnosis. Malignancy, a differential diagnosis of pulmonary amyloidosis, must be excluded: histological examinations are overriding. Difference between systemic and localized amyloidosis conditions treatment and prognosis. This observation emphasizes the difficulty to establish the diagnosis of pulmonary nodular amyloidosis and the complex relationship between amyloidosis and thromboembolism.

Is the Slow Vital Capacity Clinically Useful to Uncover Airflow Limitation in Subjects With Preserved FEV1/FVC Ratio?

BACKGROUND: FVC may underestimate the slow vital capacity (SVC) due to early closure of the small airways at low lung volumes in the forced maneuver. It remains unclear whether using SVC instead of FVC in the FEV1/vital capacity (VC) ratio increases the yield of spirometry in detecting airflow limitation or, alternatively, leads to a false-positive finding for obstruction. METHODS: This study included 13,893 adult outpatients with FEV1/FVC and total lung capacity at or above the lower limit of normal. A cluster of clinical and physiological variables defined the probability of airway disease and dysfunction, respectively. RESULTS: The prevalence of "discordance" (preserved FEV1/FVC but low FEV1/SVC) was 20.4%: discordant subjects had lower mid-expiratory flows, higher airway resistance, worse gas trapping, and ventilation distribution abnormalities than "concordant" subjects (both ratios preserved) (P < .05). Regardless of sex, age < 60 years, BMI > 30 kg/m2, and FEV1 > 70% predicted were associated with discordance (P < .001). Discordant subjects with preserved FEV1/FVC but low FEV1/SVC were four times more likely to be diagnosed with an obstructive airway disease by a respirologist compared with those with preserved FEV1/SVC and FEV1/FVC. The only exception was in the elderly subgroup with discordance (age > 70 years): only 10% of these subjects were subsequently diagnosed with an airway disease (P > .05). CONCLUSIONS: Using SVC instead of FVC in the FEV1/VC ratio enhances the yield of spirometry in detecting mild airflow obstruction in younger and obese subjects. The FEV1/SVC ratio, however, should be used with caution in elderly subjects with preserved FEV1/FVC because a low value may represent a false-positive finding for airflow limitation.

Acetaminophen Use: An Unusual Cause of Drug-Induced Pulmonary Eosinophilia.

Pulmonary eosinophilia (PE) can be found in very diverse pathological processes. Several medications have also been associated with this entity. Acetaminophen is a medication commonly used in multiple different drug formulations, many of which are available without a prescription. It has however been associated with pulmonary eosinophilia (eosinophilic pneumonia) in a few cases in Japan. We describe the case of a 68-year-old Caucasian female who presented with new persistent dry cough and dyspnea on exertion after she started using up to 4 grams of acetaminophen on a daily basis. Chest imaging revealed peripheral lower lung zone ground glass and reticular opacities, and increased eosinophils were present on bronchoalveolar lavage (BAL). The patient's symptoms markedly improved upon acetaminophen cessation, and significantly decreased eosinophils were seen on repeat BAL. To our knowledge, this is the first case of likely acetaminophen-induced pulmonary eosinophilia reported outside Japan.

Controlled production of sub-millimeter liquid core hydrogel capsules for parallelized 3D cell culture.

Liquid core capsules having a hydrogel membrane are becoming a versatile tool for three-dimensional culture of micro-organisms and mammalian cells. Making sub-millimeter capsules at a high rate, via the breakup of a compound jet in air, opens the way to high-throughput screening applications. However, control of the capsule size monodispersity, especially required for quantitative bioassays, was still lacking. Here, we report how the understanding of the underlying hydrodynamic instabilities that occur during the process can lead to calibrated core-shell bioreactors. The requirements are: i) damping the shear layer instability that develops inside the injector arising from the co-annular flow configuration of liquid phases having contrasting viscoelastic properties; ii) controlling the capillary instability of the compound jet by superposing a harmonic perturbation onto the shell flow; iii) avoiding coalescence of drops during jet fragmentation as well as during drop flight towards the gelling bath; iv) ensuring proper engulfment of the compound drops into the gelling bath for building a closed hydrogel shell. We end up with the creation of numerous identical compartments in which cells are able to form multicellular aggregates, namely spheroids. In addition, we implement an intermediate composite hydrogel layer, composed of alginate and collagen, allowing cell adhesion and thus the formation of epithelia or monolayers of cells.

Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries).

This review aims to answer the most common questions in routine surgical practice during the first 48 h of blunt chest trauma (BCT) management. Two authors identified relevant manuscripts published since January 1994 to January 2014. Using preferred reporting items for systematic reviews and meta-analyses statement, they focused on the surgical management of BCT, excluded both child and vascular injuries and selected 80 studies. Tension pneumothorax should be promptly diagnosed and treated by needle decompression closely followed with chest tube insertion (Grade D). All traumatic pneumothoraces are considered for chest tube insertion. However, observation is possible for selected patients with small unilateral pneumothoraces without respiratory disease or need for positive pressure ventilation (Grade C). Symptomatic traumatic haemothoraces or haemothoraces >500 ml should be treated by chest tube insertion (Grade D). Occult pneumothoraces and occult haemothoraces are managed by observation with daily chest X-rays (Grades B and C). Periprocedural antibiotics are used to prevent chest-tube-related infectious complications (Grade B). No sign of life at the initial assessment and cardiopulmonary resuscitation duration >10 min are considered as contraindications of Emergency Department Thoracotomy (Grade C). Damage Control Thoracotomy is performed for either massive air leakage or refractive shock or ongoing bleeding enhanced by chest tube output >1500 ml initially or >200 ml/h for 3 h (Grade D). In the case of haemodynamically stable patients, early video-assisted thoracic surgery is performed for retained haemothoraces (Grade B). Fixation of flail chest can be considered if mechanical ventilation for 48 h is probably required (Grade B). Fixation of sternal fractures is performed for displaced fractures with overlap or comminution, intractable pain or respiratory insufficiency (Grade D). Lung herniation, traumatic diaphragmatic rupture and pericardial rupture are life-threatening situations requiring prompt diagnosis and surgical advice. (Grades C and D). Tracheobronchial repair is mandatory in cases of tracheal tear >2 cm, oesophageal prolapse, mediastinitis or massive air leakage (Grade C). These evidence-based surgical indications for BCT management should support protocols for chest trauma management.