Nanoporous antireflection coating for high-temperature applications in the infrared.

Antireflection (AR) coatings are essential to the performance of optical systems; without them, surface reflections increase significantly at steep angles and become detrimental to the functionality. AR coatings apply to a wide range of applications from solar cells and laser optics to optical windows. Many times, operational conditions include high temperatures and steep angles of incidence (AOIs). The implementation of AR coatings is extremely challenging in these conditions. Nanoporous coatings made from high-temperature-tolerant materials offer a solution to this problem. The careful selection of materials is needed to prevent delamination when exposed to high temperatures, and an optimal optical design is needed to lower surface reflections at both the normal incidence and steep AOIs. This paper presents nanoporous silicon dioxide and hafnium dioxide coatings deposited on a sapphire substrate using oblique angle deposition by electron beam evaporation, a highly accurate deposition technique for thin films. Developed coatings were tested in a controlled temperature environment and demonstrated thermal stability at temperatures up to 800°C. Additional testing at room temperature demonstrated the reduction of power reflections near optimal for AOIs up to 70° for a design wavelength of 1550 nm. These findings are promising to help extend the operation of technology at extreme temperatures and steep angles.

Clinician Knowledge of Societal Guidelines on Management of Gastrointestinal Complications in Esophageal Atresia.

OBJECTIVES: The aim of this study was to assess whether clinicians approached the management of children with esophageal atresia (EA) in accordance with the 2016 European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society of Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines on the management of gastrointestinal and nutritional complications in this cohort. METHODS: We invited expert physicians and surgeons closely involved in the care of children with EA (members of the International network on esophageal atresia [INoEA], ESPGHAN EA working group, French national EA registry, European pediatric surgical association (EUPSA), and European rare disease reference network [ERNICA]) to participate in an anonymous online survey containing 15 multiple choice questions concerning the management of gastrointestinal and nutritional complications in children with EA. Questions were based on the management of gastroesophageal reflux disease (GERD) dysphagia, cyanotic spells, feeding and nutrition, anastamotic strictures, and transition to adult care as detailed in the 2016 guidelines. RESULTS: Median concordance with ESPGHAN/NASPHAN EA Guidelines was 69% (16-100%, SD 16%) across all responders. Areas of greatest concordance were in the fields of surveillance endoscopy and medical management of GERD. Areas for potential educational opportunities include: the differential diagnosis and appropriate investigation of dysphagia and the diagnostic evaluation of extraesophageal symptoms. CONCLUSIONS: This survey highlights the importance of improving the understanding and adherence to the EA guidelines amongst clinicians involved in the care of these patients.

The Effect of Use of Individualized Pain Plans in Sickle Cell Patients Presenting to the Emergency Department.

STUDY OBJECTIVE: Sickle cell disease (SCD) is an inherited hematologic disorder that affects approximately 100,000 US individuals and results in greater than 200,000 emergency department (ED) visits annually in the United States, with pain being the most common complaint. The objective of this retrospective study is to determine the effect of implementing individualized pain plans in the treatment of patients with SCD in the ED on time to first opioid, length of stay, and disposition. METHODS: At The Ohio State University Wexner Medical Center, a multidisciplinary group including hematologists and ED physicians was formed and enacted a protocol for using individualized pain plans, with the goal of decreasing time to treatment for patients with SCD who presented to the ED with chief complaint of pain. In this retrospective study, data from the year before through the year of implementation were gathered. Generalized linear models were fit to compare time to first opioid, length of stay, and disposition before and after protocol implementation. RESULTS: Data showed a 48% decrease in time to first opioid and a 22% decrease in length of ED stay after protocol implementation. No significant change was found in disposition or length of inpatient admission before and after protocol initiation. CONCLUSION: The use of individualized pain plans in the treatment of patients with SCD in the ED is a useful method of not only ensuring rapid and adequate treatment but also decreasing use of health care resources.

Holographic imaging through a scattering medium by diffuser-aided statistical averaging.

We introduce a practical digital holographic method capable of imaging through a diffusive or scattering medium. The method relies on statistical averaging from a rotating ground glass diffuser to negate the adverse effects caused by speckle introduced by a static diffuser or scattering medium. In particular, a setup based on Fourier transform holography is used to show that an image can be recovered after scattering by introducing an additional diffuser in the optical setup. This method is capable of recovering object information from behind a scattering layer in biomedical or military imaging applications.

Role of Esophageal High-Resolution Manometry in Pediatric Patients.

Purpose: Dysphagia, vomiting and feeding difficulties are common symptoms, with which children present. Esophageal function testing with high resolution manometry can help in diagnosing and treating these patients. We aim to access the clinical utility of high-resolution manometry of esophagus in symptomatic pediatric patients. Methods: A retrospective chart review was done on all symptomatic patients who underwent esophageal high-resolution manometry between 2010 and 2019 at Sydney Children's Hospital, Australia. Manometry results were categorized based on Chicago classification. Demographic data, indication of procedure, manometric findings, and details of treatment changes were obtained and analyzed. Results: There were 62 patients with median age of 10 years (9 months-18 years). The main indication for the procedure was dysphagia (56%). Thirty-two percent of patients had a co-morbid condition, with esophageal atresia accounting for 16%. The majority (77%) of patients had abnormal manometry which included, ineffective esophageal motility in 45.2%. In esophageal atresia cohort, esophageal pressurization was seen in 50%, aperistalsis in 40% and 10% with prior fundoplication had esophago-gastric junction obstruction. Patients with esophago-gastric junction obstruction or achalasia were treated by either pneumatic dilation or Heller's myotomy. Patients with ineffective esophageal motility and rumination were treated with a trial of prokinetics/dietary texture modification and diaphragmatic breathing. Conclusion: Esophageal high-resolution manometry has a role in the evaluation of symptomatic pediatric patients. The majority of our patients had abnormal results which led to change in treatments, with either medication, surgery and/or feeding modification with resultant improvement in symptoms.

Customized USB flash drives used to promote library resources and services to first-year medical and dental students.

In line with its institution's commitment to keep new student orientation/welcome events "green," Columbia University's Health Sciences Library (HSL) applied for a National Network of Libraries of Medicine Middle Atlantic Region (NN/LM MAR) Small Projects Award(1) in Spring/Summer 2009 to explore paperless modes of outreach. This article describes the project that resulted from this funding, whose purpose was to determine whether customized 1 GB USB flash drives are a good vehicle for distributing library promotional materials to incoming medical and dental students. This project gave HSL librarians the opportunity to connect with students in a way that had not been done before and to consider how these new students use/view the information the library produces.

The effect of neighborhood Area Deprivation Index on residential burn injury severity.

INTRODUCTION: Residential fires account for the majority of burn-related injuries and fatalities. Established risk factors for burn injury include male gender, racial minority, children and elderly individuals, poverty, and substandard housing characteristics. In North Carolina, the rate of residential fire injuries and deaths is higher than the national average. Therefore, we sought to describe residential fire hospitalizations at a large regional burn center and describe the neighborhoods in which they live. We hypothesized that patients living in areas with higher Area Deprivation Index (ADI) are more likely to have major residential burns. METHODS: We conducted a retrospective analysis of burn admissions from January 2002 to December 2015. We dichotomized patients into two cohorts: residential and non-residential burns and performed a bivariate analysis. Multivariate Poisson regression models were utilized to determine if ADI was associated with inhalation injury and ≥20% total body surface area burn. RESULTS: Of the 10,506 patients presented during the study period. Of these, 10,016 (95.3%) patients resided in North Carolina, and 7894 (78.8%) had a residential burn. Of the overall cohort, 6.0% (n=458) of patients had ≥20% TBSA burns and 6.4% (n=506) had inhalation injury. The majority of patients were in the highest (most disadvantaged) ADI quartile (n=3050, 39.5%), and only 6.8% of patients (n=525) were in the lowest (least disadvantaged) ADI quartile. In the Poisson multivariate regressions to determine if the ADI was associated with severe burns, patients in the highest ADI quartile had an increased relative risk of ≥20% TBSA burn (RR 1.31, 95% CI 1.02-1.68) and inhalation injury (RR 1.39, 95% CI 1.09-1.76) when compared to patients in the second-lowest ADI quartile when controlled for pertinent covariates. CONCLUSION: Residential structure fires represent the major source of burns and fatalities. People who reside in the highest ADI quartile are more like to present with higher burn injury severity in terms of burn size and the presence of inhalation injury. The use of the ADI to target neighborhoods for burn prevention is imperative.

Differential privacy for public health data: An innovative tool to optimize information sharing while protecting data confidentiality.

Coronavirus disease 2019 (COVID-19) has highlighted the need for the timely collection and sharing of public health data. It is important that data sharing is balanced with protecting confidentiality. Here we discuss an innovative mechanism to protect health data, called differential privacy. Differential privacy is a mathematically rigorous definition of privacy that aims to protect against all possible adversaries. In layperson's terms, statistical noise is applied to the data so that overall patterns can be described, but data on individuals are unlikely to be extracted. One of the first use cases for health data in Australia is the development of the COVID-19 Real-Time Information System for Preparedness and Epidemic Response (CRISPER), which provides proof of concept for the use of this technology in the health sector. If successful, this will benefit future sharing of public health data.

Development of the COVID-19 Real-Time Information System for Preparedness and Epidemic Response (CRISPER), Australia.

Accurate and current information has been highlighted across the globe as a critical requirement for the COVID-19 pandemic response. To address this need, many interactive dashboards providing a range of different information about COVID-19 have been developed. A similar tool in Australia containing current information about COVID-19 could assist general practitioners and public health responders in their pandemic response efforts. The COVID-19 Real-time Information System for Preparedness and Epidemic Response (CRISPER) has been developed to provide accurate and spatially explicit real-time information for COVID-19 cases, deaths, testing and contact tracing locations in Australia. Developed based on feedback from key users and stakeholders, the system comprises three main components: (1) a data engine; (2) data visualization and interactive mapping tools; and (3) an automated alert system. This system provides integrated data from multiple sources in one platform which optimizes information sharing with public health responders, primary health care practitioners and the general public.

The Oncologic Emergency Medicine Fellowship.

The United States cancer population is growing and is projected to grow further. The current cancer population has a high rate of emergency department admission. Further training about oncologic emergencies may be needed and would ideally strive to care for the whole patient, including sequelae of the malignancy, progressive disease, symptom control, adverse effects of treatment, and palliative care. The James Cancer Hospital at The Ohio State University Wexner Medical Center and The University of Texas MD Anderson Cancer Center fellowship training programs in oncologic emergency medicine are described.

The Use of Phallometric Evidence in Canadian Criminal Law.

The use of phallometric evidence by Canadian criminal courts has steadily increased since the early 1980s. Phallometry was initially considered by courts to be a potentially useful tool in the determination of accused persons' culpability; however, its contemporary use is limited to the postconviction contexts of sentencing and dangerous and long-term offender applications, as one of several means of diagnosing offenders, determining recidivism risk, and assessing treatment prospects. We provide an overview and assessment of the use of phallometric evidence by Canadian criminal courts and conclude that its contemporary application appears to be consistent with the expert psychiatric consensus on its proper role and function in the forensic context. We further identify potential difficulties associated with the adequacy of offenders' consent and the occasional divergence of expert opinion about the reliability and validity of phallometry for diagnosis and risk assessment.

Localizing sadness activation within the subgenual cingulate in individuals: a novel functional MRI paradigm for detecting individual differences in the neural circuitry underlying depression.

Variations in frontal lobe (FL) functional anatomy, especially the subgenual cingulate gyrus (SGC) suggest that mapping on an individual rather than group level may give greater insight regarding dysregulation of the neural circuitry involved in depression, as well as potentially provide more specific or individualized treatment plans for depressed patients. We designed a functional MRI task capable of imaging FL activity in individuals, including the SGC region, using a transient sadness paradigm. We sought to develop a method that may better detect individual differences of FL subregions related to sadness, since this region has been implicated to show dysregulation in depression. The task was based on a block design that also accommodates individual differences in responsivity to a sadness induction paradigm. Individual differences from nine non-depressed healthy volunteers were analyzed. We also performed functional connectivity analyses to further characterize our findings to the networks associated with the SGC in each individual. The study was designed to account for individual variation rather than using a true experimental design; therefore, no control group was necessary. As expected, due to inter-individual variability, the specific site of SGC activation during sadness varied across individuals. Activation was also observed in other brain regions consistent with other studies of induced sadness and depression. Patterns of functional connectivity to the SGC also highlighted neural circuits known to subserve sadness and depression. This task promises to more precisely localize a given individual's functional organization of the brain circuitry underlying sadness, and potentially depression, in an efficient, standardized way. This task could potentially aid in providing individualized targets in the treatment of depression.