L-Pampo™, a Novel TLR2/3 Agonist, Acts as a Potent Cancer Vaccine Adjuvant by Activating Draining Lymph Node Dendritic Cells.

TLR agonists have emerged as an efficient cancer vaccine adjuvant system that induces robust immune responses. L-pampo™, a proprietary vaccine adjuvant of TLR2 and TLR3 agonists, promotes strong humoral and cellular immune responses against infectious diseases. In this study, we demonstrate that vaccines formulated with L-pampo™ affect the recruitment and activation of dendritic cells (DCs) in draining lymph nodes (dLNs) and leading to antigen-specific T-cell responses and anti-tumor efficacy. We analyzed DC maturation and T-cell proliferation using flow cytometry and ELISA. We determined the effect of L-pampo™ on DCs in dLNs and antigen-specific T-cell responses using flow cytometric analysis and the ELISPOT assay. We employed murine tumor models and analyzed the anti-tumor effect of L-pampo™. We found that L-pampo™ directly enhanced the maturation and cytokine production of DCs and, consequently, T-cell proliferation. OVA or OVA peptide formulated with L-pampo™ promoted DC migration into dLNs and increased activation markers and specific DC subsets within dLNs. In addition, vaccines admixed with L-pampo™ promoted antigen-specific T-cell responses and anti-tumor efficacy. Moreover, the combination of L-pampo™ with an immune checkpoint inhibitor synergistically improved the anti-tumor effect. This study suggests that L-pampo™ can be a potent cancer vaccine adjuvant and a suitable candidate for combination immunotherapy.

Barriers to Lactulose Adherence in Patients with Cirrhosis and Hepatic Encephalopathy.

BACKGROUND: Hepatic encephalopathy (HE) is a major cause of mortality and morbidity in patients with cirrhosis. Lactulose non-adherence is one of the most frequently reported precipitants of hospital admission for HE. AIMS: We aimed to identify which factors contribute most to lactulose non-adherence and propose strategies to promote greater adherence and utilization of lactulose. METHODS: Participants in this study consisted of patients with cirrhosis who were taking lactulose for prevention of HE. Subjects were administered the Morisky Adherence Scale 8 (MAS-8) and a customized 16-question survey that assessed barriers to lactulose adherence. Results from the MAS-8 were used to stratify subjects into "adherent" and "non-adherent" groups. Survey responses were compared between groups. RESULTS: We enrolled 129 patients in our study, of whom 45 were categorized as "adherent and 72 were categorized as "non-adherent." Barriers to adherence included large volumes of lactulose, high frequency of dosing, difficulty remembering to take the medication, unpleasant taste, and medication side-effects. Most patients (97%) expressed understanding of the importance of lactulose, and 71% of patients felt that lactulose was working to manage their HE. Hospital admission rates for HE was higher in non-adherent patients, although this difference was not statistically significant. CONCLUSION: We identified several factors that contribute to lactulose non-adherence among patients treated for HE. Many of these factors are potentially modifiable. Patient and care-giver education are critical to assure adherence. Pharmacists and nurses are an essential but underutilized aspect of education regarding proper medication use.

Recall patterns and risk of primary liver cancer for subcentimeter ultrasound liver observations: a multicenter study.

BACKGROUND: Patients with cirrhosis and subcentimeter lesions on liver ultrasound are recommended to undergo short-interval follow-up ultrasound because of the presumed low risk of primary liver cancer (PLC). AIMS: The aim of this study is to characterize recall patterns and risk of PLC in patients with subcentimeter liver lesions on ultrasound. METHODS: We conducted a multicenter retrospective cohort study among patients with cirrhosis or chronic hepatitis B infection who had subcentimeter ultrasound lesions between January 2017 and December 2019. We excluded patients with a history of PLC or concomitant lesions ≥1 cm in diameter. We used Kaplan Meier and multivariable Cox regression analyses to characterize time-to-PLC and factors associated with PLC, respectively. RESULTS: Of 746 eligible patients, most (66.0%) had a single observation, and the median diameter was 0.7 cm (interquartile range: 0.5-0.8 cm). Recall strategies varied, with only 27.8% of patients undergoing guideline-concordant ultrasound within 3-6 months. Over a median follow-up of 26 months, 42 patients developed PLC (39 HCC and 3 cholangiocarcinoma), yielding an incidence of 25.7 cases (95% CI, 6.2-47.0) per 1000 person-years, with 3.9% and 6.7% developing PLC at 2 and 3 years, respectively. Factors associated with time-to-PLC were baseline alpha-fetoprotein >10 ng/mL (HR: 4.01, 95% CI, 1.85-8.71), platelet count ≤150 (HR: 4.90, 95% CI, 1.95-12.28), and Child-Pugh B cirrhosis (vs. Child-Pugh A: HR: 2.54, 95% CI, 1.27-5.08). CONCLUSIONS: Recall patterns for patients with subcentimeter liver lesions on ultrasound varied widely. The low risk of PLC in these patients supports short-interval ultrasound in 3-6 months, although diagnostic CT/MRI may be warranted for high-risk subgroups such as those with elevated alpha-fetoprotein levels.

Evaluating attention deficit hyperactivity disorder symptoms in children and adolescents through tracked head movements in a virtual reality classroom: The effect of social cues with different sensory modalities.

Background: Attention deficit hyperactivity disorder (ADHD) is clinically diagnosed; however, quantitative analysis to statistically analyze the symptom severity of children with ADHD via the measurement of head movement is still in progress. Studies focusing on the cues that may influence the attention of children with ADHD in classroom settings, where children spend a considerable amount of time, are relatively scarce. Virtual reality allows real-life simulation of classroom environments and thus provides an opportunity to test a range of theories in a naturalistic and controlled manner. The objective of this study was to investigate the correlation between participants' head movements and their reports of inattention and hyperactivity, and to investigate how their head movements are affected by different social cues of different sensory modalities. Methods: Thirty-seven children and adolescents with (n = 20) and without (n = 17) ADHD were recruited for this study. All participants were assessed for diagnoses, clinical symptoms, and self-reported symptoms. A virtual reality-continuous performance test (VR-CPT) was conducted under four conditions: (1) control, (2) no-cue, (3) visual cue, and (4) visual/audio cue. A quantitativecomparison of the participants' head movements was conducted in three dimensions (pitch [head nods], yaw [head turns], and roll [lateral head inclinations]) using a head-mounted display (HMD) in a VR classroom environment. Task-irrelevant head movements were analyzed separately, considering the dimension of movement needed to perform the VR-CPT. Results: The magnitude of head movement, especially task-irrelevant head movement, significantly correlated with the current standard of clinical assessment in the ADHD group. Regarding the four conditions, head movement showed changes according to the complexity of social cues in both the ADHD and healthy control (HC) groups. Conclusion: Children and adolescents with ADHD showed decreasing task-irrelevant movements in the presence of social stimuli toward the intended orientation. As a proof-of-concept study, this study preliminarily identifies the potential of VR as a tool to understand and investigate the classroom behavior of children with ADHD in a controlled, systematic manner.

Intratumoral immunotherapy using a TLR2/3 agonist, L-pampo, induces robust antitumor immune responses and enhances immune checkpoint blockade.

BACKGROUND: Toll-like receptors (TLRs) are critical innate immune sensors that elicit antitumor immune responses in cancer immunotherapy. Although a few TLR agonists have been approved for the treatment of patients with early-stage superficial cancers, their therapeutic efficacy is limited in patient with advanced invasive cancers. Here, we identified the therapeutic role of a TLR2/3 agonist, L-pampo (LP), which promotes antitumor immunity and enhances the immune checkpoint blockade. METHODS: We generated LP by combining a TLR2 agonist, Pam3CSK4, with a TLR3 agonist, Poly (I:C). Immune responses to stimulation with various TLR agonists were compared. Tumor-bearing mice were intratumorally treated with LP, and their tumor sizes were measured. The antitumor effects of LP treatment were determined using flow cytometry, multiplexed imaging, and NanoString nCounter immune profiling. The immunotherapeutic potential of LP in combination with α-programmed cell death protein-1 (PD-1) or α-cytotoxic T-lymphocytes-associated protein 4 (CTLA-4) was evaluated in syngeneic MC38 colon cancer and B16F10 melanoma. RESULTS: The LP treatment induced a potent activation of T helper 1 (Th1) and 2 (Th2)-mediated immunity, tumor cell apoptosis, and immunogenic tumor cell death. Intratumoral LP treatment effectively inhibited tumor progression by activating tumor-specific T cell immunity. LP-induced immune responses were mediated by CD8+ T cells and interferon-γ, but not by CD4+ T cells and CD25+ T cells. LP simultaneously activated TLR2 and TLR3 signaling, thereby extensively changing the immune-related gene signatures within the tumor microenvironment (TME). Moreover, intratumoral LP treatment led to systemic abscopal antitumor effects in non-injected distant tumors. Notably, LP treatment combined with ɑPD-1 and ɑCTLA-4 further enhanced the efficacy of monotherapy, resulting in complete tumor regression and prolonged overall survival. Furthermore, LP-based combination immunotherapy elicited durable antitumor immunity with tumor-specific immune memory in colon cancer and melanoma. CONCLUSIONS: Our study demonstrated that intratumoral LP treatment improves the innate and adaptive antitumor immunity within the TME and enhances the efficacy of αPD-1 and αCTLA-4 immune checkpoint blockade.

Spontaneous Seroclearance Is Associated with Lower Liver Fibrosis in Treatment-Naïve Chronic Hepatitis B Patients.

BACKGROUND: Chronic hepatitis B virus (HBV) is a major public health concern. Transient elastrography (TE) is a reliable method in assessing hepatic fibrosis in patients with liver disease. We assess the potential clinical associations between HBsAg seroclearance and the severity of liver fibrosis. METHODS: We retrospectively performed a matched analysis of 23 consecutive HBsAg seroclearance patients who underwent TE between March 2008 and August 2021 from a community practice at a 1:3 ratio based on clinic visit date. Baseline laboratory and clinical data were collected. Fisher's exact test and Chi-square test for proportions, and Wilcoxon rank-sum test for median were performed. RESULTS: Twenty-three cases and 69 controls were identified. Median follow up (interquartile range) for the cases and controls was 24,314 (1402) and 2332 (1587) days (p = 0.15), respectively. All patients were Asian. Median age of cases was higher than controls (64 vs 52, p < 0.01, respectively). While most comorbidities were similar, diabetes and hyperlipidemia were more prevalent in cases. Baseline HBV DNA was detectable in 78% of cases and 97% of controls (p < 0.01). More cases had baseline HBsAg titers below 1000 IU/mL than controls (81% vs 8.7%, p < 0.01). Other baseline laboratory values were similar. Few cases had a fibrosis score greater than 1, while control had over a quarter of patients with a fibrosis score of 2 or 3. CONCLUSION: Spontaneous HBsAg seroclearance remains rare in patients with chronic HBV infection. It is associated with low baseline HBsAg, and lower level of liver fibrosis as detected by TE.

Barriers for Liver Transplant in Patients with Alcohol-Related Hepatitis.

BACKGROUND: Liver transplantation (LT) for alcohol-related liver disease has historically been reserved for patients who have been six months abstinent. Given the increasing incidence of alcohol-related hepatitis (AH) and dismal survival in patients who fail medical therapy, transplant centers are extending their acceptance criteria for patients with less than 6 months of sobriety. We sought to determine the barriers for listing. METHODS: We conducted a retrospective chart review of all inpatient LT referrals for a diagnosis of AH between September 2019 and December 2020. LT evaluations were performed by a multidisciplinary team. Descriptive statistics were reported using mean and standard deviation (SD) or percentage where appropriate. RESULTS: During our study period, 82 patients were evaluated for LT. Of these 82 patients, 62 were declined for liver transplantation. The mean (SD) age of the 62-patient cohort was 44 years (10.7), and most patients were men. The mean (SD) number of reasons for denial was 2 (0.97). Four patients had medical contraindications for transplant. Twenty-seven (44%) and 35 (56%) patients lacked insight and were at risk of alcohol relapse, respectively. Forty-three (69%) and fourteen (22.5%) patients had insufficient social support and an inability to maintain a therapeutic relationship with the transplant team, respectively. CONCLUSION: Patients are more likely denied for psychosocial factors than medical comorbidities. The majority were due to lack of insight, insufficient social support, and inability to maintain a therapeutic relationship with the transplant team. Resources should be allocated to address these issues.

Timely Diagnosis of Pneumoperitoneum by Point-of-care Ultrasound in the Emergency Department: A Case Series.

INTRODUCTION: Pneumoperitoneum is a life-threatening diagnosis that requires timely diagnosis and action. We present a case series of patients with perforated hollow viscus who were accurately diagnosed by emergency physicians using point-of-care ultrasound (POCUS) while in the emergency department (ED). CASE SERIES: Three elderly patients presented to the ED with the complaints of syncope, abdominal pain with constipation, and unresponsiveness. The emergency physicians used POCUS to diagnose and then expedite the necessary treatment. CONCLUSION: Point-of-care ultrasound can be used by emergency physicians to diagnose pneumoperitoneum in the ED.

COVID-19 Subunit Vaccine with a Combination of TLR1/2 and TLR3 Agonists Induces Robust and Protective Immunity.

The development of COVID-19 vaccines is critical in controlling global health issues under the COVID-19 pandemic. The subunit vaccines are the safest and most widely used vaccine platform and highly effective against a multitude of infectious diseases. An adjuvant is essential for subunit vaccines to enhance the magnitude and durability of immune responses. In this study, we determined whether a combination of toll-like receptor (TLR)1/2 and TLR3 agonists (L-pampo) can be a potent adjuvant for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) subunit vaccine. We measured a neutralizing antibody (nAb) and an angiotensin-converting enzyme 2 (ACE2) receptor-blocking antibody against SARS-CoV-2 receptor-binding domain (RBD). We also detected interferon-gamma (IFN-γ) production by using ELISPOT and ELISA assays. By employing a ferret model, we detected nAbs and IFN-γ producing cells and measured viral load in nasal wash after the challenge of SARS-CoV-2. We found that SARS-CoV-2 antigens with L-pampo stimulated robust humoral and cellular immune responses. The efficacy of L-pampo was higher than the other adjuvants. Furthermore, in the ferret model, SARS-CoV-2 antigens with L-pampo elicited nAb response and antigen-specific cellular immune response against SARS-CoV-2, resulting in substantially decreased viral load in their nasal wash. Our study suggests that SARS-CoV-2 antigens formulated with TLR agonists, L-pampo, can be a potent subunit vaccine to promote sufficient protective immunity against SARS-CoV-2.

History of Hepatic Encephalopathy Is Not a Contraindication to Transjugular Intrahepatic Portosystemic Shunt Placement for Refractory Ascites.

INTRODUCTION: The outcomes of transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with hepatic encephalopathy (HE) are controversial. We studied the relationship of pre-TIPS HE in patients undergoing TIPS for refractory ascites on all-cause mortality and development of post-TIPS HE. METHODS: A single-center retrospective comparison study was performed for patients undergoing TIPS for refractory ascites. Survival by history of pre-TIPS HE was demonstrated with Kaplan-Meier curves. Univariate and multivariate logistic regression analyses were performed to identify the predictors of post-TIPS clinical outcomes for patients with and without pre-TIPS HE. RESULTS: We identified 202 TIPS recipients (61% male, mean ± SD; age 59.1 ± 10.2 years; mean model for end-stage liver disease score 17.3 ± 6.9). Pre-TIPS HE did not predispose patients for increased all-cause mortality, increased risk of experiencing HE within 60 days, or increased risk of hospital admission for HE within 6 months. A multivariate analysis demonstrated that total bilirubin (odds ratio [OR] 1.03; P = 0.016) and blood urea nitrogen (OR 1.15; P = 0.002) were predictors for all-cause mortality within 6 months post-TIPS. Age ≥65 years (OR 3.92; P = 0.004), creatinine (OR 2.22; P = 0.014), and Child-Pugh score (OR 1.53; P = 0.006) were predictors for HE within 60 days post-TIPS. Predictors of intensive care admission for HE within 6 months post-TIPS included age ≥65 years (OR 8.84; P = 0.018), history of any admission for HE within 6 months pre-TIPS (OR 8.42; P = 0.017), and creatinine (OR 2.22; P = 0.015). DISCUSSION: If controlled, pre-TIPS HE does not adversely impact patient survival or clinical outcomes, such as development of HE within 60 days of TIPS or hospital admission for HE within 6 months. Patients may be able to undergo TIPS for refractory ascites despite a history of HE.

Frailty Does Not Impact Caregiver Burden in Patients with Cirrhosis.

BACKGROUND: Frailty is common and is associated with increased mortality, lower quality of life, and higher readmission rates in cirrhotic patients. Not only are these outcomes important, but further understanding the impact of frailty on a caregiver's life is crucial to better comprehend caregiver burden in cirrhotic patients and develop strategies to improve care for patients and their caregivers. METHODS: A single-center, prospective study was conducted of cirrhotic patients and their caregivers between 4/1/2019 and 11/1/2019. Frailty testing combined aspects from the Fried Frailty Instrument, Short Physical Performance Battery, and activities of daily living. Caregivers completed questionnaires to evaluate caregiver burden using the Zarit Burden Interview (ZBI-12), and perceived social support, using the Interpersonal Support Evaluation List. RESULTS: In total, 94 cirrhotic patients were included, 50% males with a median age of 63.1 years. The most common etiology of cirrhosis was nonalcoholic steatohepatitis. Frailty was prevalent (45.1%). In total, 12.8% of caregivers reported a high burden based on ZBI-12. There was no association between frailty and caregiver burden, hospitalization rates, or death. However, frailty was associated with a higher number of outpatient GI visits (p = 0.002). Lower perceived social support among caregivers was associated with a higher caregiver burden (p < 0.0001). CONCLUSION: Frailty is prevalent in cirrhotic patients but is not associated with higher rates of caregiver burden. Low perceived social support among caregivers, however, was associated with higher caregiver burden. It is important to recognize the impact of caregiver burden on caregivers of cirrhotic patients and ensure caregivers have the appropriate support to mitigate burden.

Older Patients With Hepatocellular Carcinoma Are Less Knowledgeable About Survivorship Issues: Outcomes from a Survey-based Study.

BACKGROUND AND AIMS: As the incidence and survival for hepatocellular carcinoma increase, the number of patients having been treated for liver cancer would be expected to increase as well. Little is known about the experience of the survivors of hepatocellular carcinoma. METHODS: The authors conducted a 3-tool survey of hepatocellular carcinoma survivors at a large, academic, and tertiary referral medical center to assess potential areas of disparities in the survivorship experience. The instruments aimed to assess knowledge of survivorship issues (Perceived Efficacy in Patient-Physician Interactions Questionnaire-1), preparedness for the survivorship experience (Perceived Efficacy in Patient-Physician Interactions Questionnaire-2), and self-efficacy in procuring medical information while navigating the patient-provider relationship (Perceived Efficacy in Patient-Physician Interactions Questionnaire). The authors compared mean test scores for each instrument, with higher scores indicating a more positive response, by patient characteristics and used s linear regression model to examine associations between sociodemographics and survey scores. RESULTS: In total, 110 patients took at least 1 survey. In the multiple linear regression model, the authors found that for every increase in patient age by 10 years, knowledge of survivorship issues decreased by a total score of 1.3 (P=0.02). In this model, the authors found no significant differences between male and female respondents, English and non-English speakers, and liver transplant recipients and nonliver transplant recipients. Survivors who had completed a 4-year college degree had significantly higher knowledge of survivorship issues than those who did not use χ testing, but this finding did not maintain significance in the multiple linear regression model. CONCLUSIONS: In a population of 110 ethnically diverse hepatocellular carcinoma survivors, the authors found older patients had gaps in knowledge of survivorship issues. Particular attention should be paid to older populations during liver cancer treatment.

Synthesis of Honeycomb-Structured Beryllium Oxide via Graphene Liquid Cells.

Using high-resolution transmission electron microscopy and electron energy-loss spectroscopy, we show that beryllium oxide crystallizes in the planar hexagonal structure in a graphene liquid cell by a wet-chemistry approach. These liquid cells can feature van-der-Waals pressures up to 1 GPa, producing a miniaturized high-pressure container for the crystallization in solution. The thickness of as-received crystals is beyond the thermodynamic ultra-thin limit above which the wurtzite phase is energetically more favorable according to the theoretical prediction. The crystallization of the planar phase is ascribed to the near-free-standing condition afforded by the graphene surface. Our calculations show that the energy barrier of the phase transition is responsible for the observed thickness beyond the previously predicted limit. These findings open a new door for exploring aqueous-solution approaches of more metal-oxide semiconductors with exotic phase structures and properties in graphene-encapsulated confined cells.

The Gastroenterologist's Guide to Preventive Management of Compensated Cirrhosis.

Despite advances in medical care, the prevalence and mortality associated with cirrhosis continue to rise. The majority of medical care and physician efforts are devoted to the management of decompensated cirrhosis and its complications of gastrointestinal hemorrhage, hepatic encephalopathy, and ascites; however, limited efforts are placed on the medical management of compensated cirrhosis. Patients with compensated cirrhosis carry a higher survival rate, and, when diagnosed early, may be screened for future decompensation. When possible, these patients can be treated for their underlying disease to prevent disease progression and avoid the need for liver transplantation. This article reviews the importance of early diagnosis, outpatient management of compensated cirrhosis, early screening for potential decompensation, and patient education.

Serial Changes in Mannose-Binding Lectin in Patients with Sepsis.

BACKGROUND: Mannose-binding lectin (MBL) deficiency leads to increased susceptibility to infection. We investigated whether serial changes in MBL levels are associated with the prognosis of patients diagnosed with septic shock, and correlated with cytokine levels. METHODS: We enrolled 131 patients with septic shock in the study. We analyzed the serum samples for MBL and cytokine levels at baseline and 7 days later. Samples on day 7 were available in 73 patients. RESULTS: We divided the patients with septic shock into four groups according to serum MBL levels (<1.3 µg/mL or ≥1.3 µg/mL) on days 1 and 7. Patients with low MBL levels on day 1 and high MBL levels on day 7 showed a favorable prognosis for 28-day survival (odds ratio, 1.96, 95% confidence interval, 1.10-2.87; p=0.087). The high MBL group on day 7 showed a significant decrease in monocyte chemoattractant protein 1, interleukin (IL)-1ß, IL-6, IL-8, interferon-γ, and granulocyte macrophage colony-stimulating factor levels compared with the low MBL group on day 7. CONCLUSION: The increase in MBL levels of patients with septic shock may suggest a favorable prognosis and attenuate pro-inflammatory and anti-inflammatory responses.

Chemical Imprinting of Crystalline Silicon with Catalytic Metal Stamp in Etch Bath.

Conventional lithography using photons and electrons continues to evolve to scale down three-dimensional nanoscale patterns, but the complexity of technology and equipment is increasing due to diffraction and scattering problems. Physical contact lithography methods, such as nanoimprint and soft lithography, have been developed as an alternative technique. These techniques imprint predefined structures on a stamp to the polymer resist and use the polymer resist as a mask to dry etch the nanostructure on the substrate. In this study, we introduce a method of chemically imprinting crystalline silicon (Si) with a catalytic stamp to enable the direct etching of the Si without using a polymer mask. A metal catalyst is deposited on the predefined structure of the stamp. The stamp physically contacts the Si in the etching bath, and metal-assisted chemical etching occurs on the semiconductor surface. Since the metal catalyst is mounted on a stamp, it can be used repeatedly. This is a technology that combines conventional lithography and etching without using a polymer resist. This technology not only produced nano/microscale arrays of circular and square holes and trench structures but also successfully produced complex eagle-shaped structures that contained such structures.

Atomic-Layer Deposition of Single-Crystalline BeO Epitaxially Grown on GaN Substrates.

We have grown a single-crystal beryllium oxide (BeO) thin film on a gallium nitride (GaN) substrate by atomic-layer deposition (ALD) for the first time. BeO has a higher thermal conductivity, bandgap energy, and dielectric constant than SiO2. As an electrical insulator, diamond is the only material on earth whose thermal conductivity exceeds that of BeO. Despite these advantages, there is no chemical-vapor-deposition technique for BeO-thin-film deposition, and thus, it is not used in nanoscale-semiconductor-device processing. In this study, the BeO thin films grown on a GaN substrate with a single crystal showed excellent interface and thermal stability. Transmission electron microscopy showed clear diffraction patterns, and the Raman shifts associated with soft phonon modes verified the high thermal conductivity. The X-ray scan confirmed the out-of-plane single-crystal growth direction and the in-plane, 6-fold, symmetrical wurtzite structure. Single-crystalline BeO was grown on GaN despite the large lattice mismatch, which suggested a model that accommodated the strain of hexagonal-on-hexagonal epitaxy with 5/6 and 6/7 domain matching. BeO has a good dielectric constant and good thermal conductivity, bandgap energy, and single-crystal characteristics, so it is suitable for the gate dielectric of power semiconductor devices. The capacitance-voltage (C-V) results of BeO on a GaN-metal-oxide semiconductor exhibited low frequency dispersion, hysteresis, and interface-defect density.

Advanced Silicon-on-Insulator: Crystalline Silicon on Atomic Layer Deposited Beryllium Oxide.

Silicon-on-insulator (SOI) technology improves the performance of devices by reducing parasitic capacitance. Devices based on SOI or silicon-on-sapphire technology are primarily used in high-performance radio frequency (RF) and radiation sensitive applications as well as for reducing the short channel effects in microelectronic devices. Despite their advantages, the high substrate cost and overheating problems associated with complexities in substrate fabrication as well as the low thermal conductivity of silicon oxide prevent broad applications of this technology. To overcome these challenges, we describe a new approach of using beryllium oxide (BeO). The use of atomic layer deposition (ALD) for producing this material results in lowering the SOI wafer production cost. Furthermore, the use of BeO exhibiting a high thermal conductivity might minimize the self-heating issues. We show that crystalline Si can be grown on ALD BeO and the resultant devices exhibit potential for use in advanced SOI technology applications.

Canaliculorhinostomy-Indications and Surgical Results.

PURPOSE: To report the surgical results of canaliculorhinostomy for patients with distal canalicular obstruction and lacking a structurally functional lacrimal sac who would otherwise require a conjunctivodacryocystorhinostomy (CDCR) with Jones tube placement. DESIGN: Retrospective observational case series. METHODS: Setting: Single tertiary institution. PERIOD: November 1994 to June 2011. PATIENT POPULATION: Sixteen patients with canalicular obstruction at or beyond 8 mm from the punctum, with an absent or unidentifiable lacrimal sac. INTERVENTION: Patients underwent canaliculorhinostomy, whereby direct anastomosis of the canaliculi or common canaliculus to the nasal mucosa was performed. MAIN OUTCOME MEASURES: Anatomic and functional success. RESULTS: Our study comprised 16 patients with a mean age of 44.9 ± 21.9 years. Ten (62.5%) were female and 6 (37.5%) male. Mean duration of follow-up was 7.8 years. Causes of an absent or unidentifiable lacrimal sac included previous trauma (n = 8, 50.0%), previous dacryocystorhinostomy (n = 4, 25.0%), chronic dacryocystitis (n = 3, 18.8%), and previous dacryocystectomy (n = 1, 6.2%). Anastomoses between the upper and lower canaliculi and the nasal mucosa was performed in 6 patients, while that between the common canaliculus and nasal mucosa was performed in 10. Anatomic and functional success rates were 87.5% (n = 14) and 81.3% (n = 13), respectively. CONCLUSION: Canaliculorhinostomy has reasonable success rates and provides an effective surgical alternative for a group of patients in whom CDCR with Jones tube placement would otherwise have been indicated.

Parental Mediation Regarding Children's Smartphone Use: Role of Protection Motivation and Parenting Style.

Parental mediation is a type of behavior that could protect children against the negative uses and effects of smartphones. Based on protection motivation theory, this research (a) predicted parental mediation based on parents' threat and efficacy perceptions and (b) predicted threat and efficacy perceptions based on parenting styles and parents' addiction to smartphone use. An online survey of 448 parents of fourth to sixth graders was conducted. Results showed that both restrictive and active parental mediation were predicted by perceived severity, response efficacy, and self-efficacy. With regard to parenting styles, (a) authoritative parenting was positively related to perceived severity as well as response- and self-efficacy, whereas (b) permissive parenting was negatively related to self-efficacy. In addition, parents' addiction was a negative predictor of perceived severity, but a positive predictor of perceived susceptibility.