BACKGROUND: Advancement in treatment has led to prolonged survival and a rising number of women living with metastatic breast cancer (MBC) in the United States. Due to its high symptom burden, it is recommended that palliative care be integrated into the standard care to help improve quality of life. However, little is known about the use of palliative care among MBC patients in the nation. OBJECTIVES: To determine utilization of palliative care consult (PCC) after metastasis and the influence of PCC on healthcare utilization in the end of life among women living with MBC in the US. METHODS: This retrospective cohort study examined a national electronic health record database to quantify the PCC use after metastasis diagnosis until death and the associations of PCC with Emergency Department (ED), Intensive Care Unit (ICU), and chemotherapies in the end-of-life women (age ≥ 18 years) living with MBC. RESULTS: From a cohort of 2615 deceased MBC patients, 37% received PCC in the last 6 months of life. Patients who had received PCC in the end-of-life were more likely to be hospitalized, admitted to ED and ICU, and receive chemotherapies in the last 60 days before death. However, patients who had received end-of-life PCC had less hospital and ED visits and received less chemotherapies after PCC initiated. CONCLUSION: While PCC can reduce end-of-life aggressive interventions, it was underutilized among patients with MBC in the end-of-life. A myriad of clinical and patient factors may still challenge timely consultation. We urge for future endeavors in developing strategies to remove barriers in the implementation, especially earlier in the disease course, to assure timely PC treatments and reduce discomfort amid aggressive interventions for MBC.
INTRODUCTION: Palliative care (PC) utilization remains low among pancreatic cancer patients. This study explores the association of PC with mental health service and pharmacotherapy utilization among pancreatic cancer patients. METHODS: Retrospective analysis was conducted on a sample of patients in the United States with newly diagnosed pancreatic cancer using Electronic Health Record data from Optum's Integrated Claims-Clinical data set. Subsequent diagnoses of anxiety and depression and PC consultation encounters were determined using ICD-9/10 codes. Adjusted associations of mental health treatments with PC and patient characteristics were quantified using multiple logistic regression. RESULTS: Among newly diagnosed pancreatic cancer patients (n = 4029), those with PC consultations exhibited a higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%). Mental health service use and pharmacotherapy varied, with the highest utilization among patients having both anxiety and depression. Treatment pattern was also influenced by age (aOR 1.832 for age <55 vs. 65-70 years). Notably, PC consultations showed no significant effect on the likelihood of documented treatment. DISCUSSION: Our study emphasizes underutilization of PC and MH treatment for pancreatic cancer patients. These findings imply a crucial need for further investigation into palliative care's role in addressing mental health concerns among pancreatic cancer patients.
As a potential material to solve rampant dendrites and hydrogen evolution reaction (HER) problem of aqueous zinc metal batteries (AZMB), hydrogel electrolytes usually require additional additives or multi-molecular network strategies to solve existing problems of ionic conductivity, mechanical properties and interface stability. However, the intrinsic zincophilic properties of the gel itself are widely neglected leading to the addition of additional molecules and the complexity of the preparation process. In this work, we innovatively utilize the characteristics of acrylamide's high zincophilic group density, activating the intrinsic zincophilic properties of PAM gel through a simple concentration control strategy which reconstructs a novel zinc-electrolyte interface different from conventional PAM electrolyte. The activated novel gel electrolyte with intrinsic zincophilic properties has high ionic conductivity and effectively suppresses water activity, thereby inhibiting HER corrosion. Meanwhile, it induces uniform deposition of (002) crystal planes, leading to excellent deposition kinetics and long cycle life, thereby ensuring high interfacial stability. Compared with conventional PAM gel electrolytes, the activated zincophilic group-rich hydrogel maintained excellent cycling stability (1â mA/cm2, 1â mAh/cm2) over 2250â hours; The Zn//MnO2 coin cell using novel zincophilic group -rich hydrogel still retains a high specific capacity of more than 170â mAh/g at 0.5â A/g after 1000 cycles.
Chiral anomaly bulk states (CABSs) can be realized by choosing appropriate boundary conditions in a finite-size waveguide composed of two-dimensional Dirac semimetals, which have unidirectional and robust transport similar to that of valley edge states. CABSs use almost all available guiding space, which greatly improves the utilization of metamaterials. Here, free-boundary-induced CABSs in elastic twisted kagome metamaterials with C_{3v} symmetry are experimentally confirmed. The robust valley-locked transport and complete valley state conversion are experimentally observed. Importantly, the sign of the group velocity near the K and K^{'} points can be reversed by suspending masses at the boundary to manipulate the onsite potential. Moreover, CABSs are demonstrated in nanoelectromechanical phononic crystals by constructing an impedance-mismatched hard boundary. These results open new possibilities for designing more compact, space-efficient, and robust elastic wave macro- and microfunctional devices.
Coherent phonon transfer via high-quality factor (Q) mechanical resonator strong coupling has garnered significant interest. Yet, the practical applications of these strongly coupled resonator devices are largely constrained by their vulnerability to fabrication defects. In this study, topological strong coupling of gigahertz frequency surface acoustic wave (SAW) resonators with lithium niobate is achieved. The nanoscale grooves are etched onto the lithium niobate surface to establish robust SAW topological interface states (TISs). By constructing phononic crystal (PnC) heterostructures, a strong coupling of two SAW TISs, achieving a maximum Rabi splitting of 22 MHz and frequency quality factor product fQm of ≈1.2 × 1013 Hz, is realized. This coupling can be tuned by adjusting geometric parameters and a distinct spectral anticrossing is experimentally observed. Furthermore, a dense wavelength division multiplexing device based on the coupling of multiple TISs is demonstrated. These findings open new avenues for the development of practical topological acoustic devices for on-chip sensing, filtering, phonon entanglement, and beyond.
Single same cell RNAseq/ATACseq multiome data provide unparalleled potential to develop high resolution maps of the cell-type specific transcriptional regulatory circuitry underlying gene expression. We present CREMA, a framework that recovers the full cis-regulatory circuitry by modeling gene expression and chromatin activity in individual cells without peak-calling or cell type labeling constraints. We demonstrate that CREMA overcomes the limitations of existing methods that fail to identify about half of functional regulatory elements which are outside the called chromatin 'peaks'. These circuit sites outside called peaks are shown to be important cell type specific functional regulatory loci, sufficient to distinguish individual cell types. Analysis of mouse pituitary data identifies a Gata2-circuit for the gonadotrope-enriched disease-associated Pcsk1 gene, which is experimentally validated by reduced gonadotrope expression in a gonadotrope conditional Gata2-knockout model. We present a web accessible human immune cell regulatory circuit resource, and provide CREMA as an R package.
Gonadotrophs , Pituitary Gland , Mice , Humans , Animals , Pituitary Gland/metabolism , Gonadotrophs/metabolism , Chromatin/genetics , Chromatin/metabolism , Regulatory Sequences, Nucleic Acid
Li-O2 batteries could deliver ultra-high theoretical energy density compared to current Li-ion batteries counterpart. The slow cathode reaction kinetics in Li-O2 batteries, however, limits their electrocatalytic performance. To this end, MoSe2 and Ni0.85 Se nanoflakes were decorated in carbon hollow nanoflowers, which were served as the cathode catalysts for Li-O2 batteries. The hexagonal Ni0.85 Se and MoSe2 show good structural compatibility with the same space group, resulting in a stable heterogeneous structure. The synergistic interaction of the unsaturated atoms and the built-in electric fields on the heterogeneous structure exposes abundant catalytically active sites, accelerating ion and charge transport and imparting superior electrochemical activity, including high specific capacities and stable cycling performance. More importantly, the lattice distances of the Ni0.85 Se (101) plane and MoSe2 (100) plane at the heterogeneous interfaces are highly matched to that of Li2 O2 (100) plane, facilitating epitaxial growth of Li2 O2 , as well as the formation and decomposition of discharge products during the cycles. This strategy of employing nonstoichiometric compounds to build heterojunctions and improve Li-O2 battery performance is expected to be applied to other energy storage or conversion systems.
INTRODUCTION: Older adults have complex, often overlapping, medical conditions requiring careful management that may lead to increased emergency department usage compared to younger adults. Parkinson's disease (PD), a progressive neurodegenerative disorder characterized by distinct motor and nonmotor features, frequently occurs with additional comorbid disease. Classifying comorbid conditions into clinical subgroups allows for further understanding of the heterogeneity in outcomes in patients with PD. The current study examines the reasons for emergency department (ED) visits in a cohort of patients with PD and identifies comorbidities that are potential risk factors for specific ED presenting conditions. METHODS: Using data from Optum's de-identified Integrated Claims-Clinical dataset years 2010-2018, patients with PD were identified based on ICD-9/10 diagnosis codes. We identified all ED visits occurring after the first observed diagnosis code for PD. Comorbid conditions were classified using the AHRQ Clinical Classification Software (CCS). We classified patients using Latent Class Analysis (LCA) and conducted multiple logistic regression models with the outcome of reason-for-visit to examine the associations with comorbidity-profile class, patient demographics, and socio-economic characteristics. RESULTS: The most common reasons for ED admission were injuries such as fractures and contusions, diseases of the circulatory system, and general signs and symptoms, including abdominal pain, malaise, and fatigue. Comorbid medical conditions often observed in this patient population include depression, diabetes mellitus, and chronic pulmonary disease. Patients in the "Poorest Health" classification of the LCA had greater odds for ED admission for diseases related to the gastrointestinal system, musculoskeletal system, and injury/poisoning categories and reduced odds for admission for diseases of the circulatory system. DISCUSSION: Patients with PD who present to the emergency department with injuries are more likely to be in poor health overall with a high comorbidity burden. Clarifying the complex medical needs of patients with PD is the first step to further individualize care, which may reduce ED visits in this population, improve quality of life, and lessen the footprint on the healthcare system.
Parkinson Disease , Humans , Aged , Parkinson Disease/complications , Parkinson Disease/epidemiology , Quality of Life , Hospitalization , Emergency Service, Hospital , Comorbidity , Retrospective Studies
In this work, we developed Manganese and Titanium based oxide composites with oxygen defects (MnOx@aTiOy) via plasma processing as anodes of lithium ion batteries. By appropriately adjusting the defect concentration, the ion transport kinetics and electrical conductivity of the electrodes are significantly improved, showing stable capacity retention. Furthermore, the incremental capacity is further activated and long-term stable cycling performance is achieved, with a specific capacity of 829.5 mAh/g at 1 A/g after 2000 cycles. To scrutinize the lithium migration paths and energy barriers in MnO2 and Mn2O3, the density functional theory (DFT) calculations is performed to explore the lithium migration paths and energy barriers. Although the transformation of MnO2 into Mn2O3 through oxygen defects was initially surmised to inhibit Li ions along their standard routes, our results indicate quite the contrary. In fact, the composite's lithium diffusion rate saw a substantial increase. This can be accredited to the pronounced enhancement of conductivity and ion transport efficiency in the amorphous and porous TiOy.
Background: Parkinson's Disease (PD) affects over 10 million people worldwide. Many PD patients experience comorbid anxiety disorders, which have been correlated with reduced quality of life and can manifest at any time during the course of PD, including prior to motor symptom onset. Purpose: Prior work has demonstrated that patients diagnosed with depression following a PD diagnosis are less likely to receive depression treatment, but no such study has been conducted for anxiety. Research Design: A cross-sectional analysis of secondary electronhic health record data was conducted. Study Sample: Data was obtained through Optum® de-identified Electronic Health Record dataset, using ICD-9 and ICD-10 diagnosis codes to determine PD status and comparing index date of anxiety and PD diagnoses to classify patients by relative time of diagnosis. Data Analysis: Multivariate logistic regression was performed to assess factors associated with receipt of mental health treatment. Results: Of PD patients with anxiety, 52% documented a diagnosis of anxiety prior to PD. Overall, 69% documented some treatment, with 79% of those diagnosed with anxiety prior to PD receiving some treatment compared to 59% of those diagnosed with anxiety on or after PD (P < 0.001). Conclusion: Patients with PD and subsequent anxiety diagnoses are less likely to receive treatment. Further study could explore reasons for variations in mental health care within the context of an existing PD diagnosis.
Parkinson Disease , Humans , Parkinson Disease/diagnosis , Quality of Life , Cross-Sectional Studies , Anxiety/diagnosis , Anxiety Disorders/complications , Anxiety Disorders/epidemiology , Depression/diagnosis
Endurance exercise is an important health modifier. We studied cell-type specific adaptations of human skeletal muscle to acute endurance exercise using single-nucleus (sn) multiome sequencing in human vastus lateralis samples collected before and 3.5 hours after 40 min exercise at 70% VO2max in four subjects, as well as in matched time of day samples from two supine resting circadian controls. High quality same-cell RNA-seq and ATAC-seq data were obtained from 37,154 nuclei comprising 14 cell types. Among muscle fiber types, both shared and fiber-type specific regulatory programs were identified. Single-cell circuit analysis identified distinct adaptations in fast, slow and intermediate fibers as well as LUM-expressing FAP cells, involving a total of 328 transcription factors (TFs) acting at altered accessibility sites regulating 2,025 genes. These data and circuit mapping provide single-cell insight into the processes underlying tissue and metabolic remodeling responses to exercise.
At present, the 100% case fatality and the cross-infection of virus strains make the ASFV 's harm to society continue to expand. The absence of an effective commercial vaccine poses early detection remains the most effective means of curbing ASFV infection. Here, we report a cascaded detection platform based on the CRISPR-Cas12a system combined with graphene field-effect transistor sensors. The cascade platform could detect ASFV as low as 0.5 aM within 30 min and achieve typing of wild and vaccine strains of ASFV in a single detection system. The evaluation of 16 clinical samples proved that, compared with the gold standard Real-time PCR method, this platform has outstanding advantages in sensitivity, specificity and typing. Combining CRISPR-Cas12a's high specificity with the bipolar electric field effect of graphene field-effect transistor, the cascade platform is expected to achieve clinical application in the field of DNA disease detection, and provides a new direction for multi-strain disease typing.
Biosensing Techniques , Graphite , CRISPR-Cas Systems/genetics , Electricity , Real-Time Polymerase Chain Reaction
Depression is a common, potentially debilitating non-motor symptom of Parkinson's disease which may manifest at any time and can respond to treatment. Although depression is a known primary mediator of health-related quality of life, it is currently unknown whether the timing of depression diagnosis relative to PD diagnosis affects receipt of depression treatment. Electronic health record data were examined to explore differences in depression treatment among patients diagnosed with depression before or after PD diagnosis. Compared to PD patients diagnosed with depression prior to PD, those diagnosed with depression following PD are less likely to receive any treatment, either pharmacologic or non-pharmacologic, indicating a temporal association between the time of PD diagnosis and receipt of depression treatment. This highlights a potentially substantial treatment gap, despite the existence of efficacious treatment. Diagnosis with PD appears to alter depression treatment and further research is warranted to determine potential causes and effective interventions.
Parkinson Disease , Humans , Parkinson Disease/complications , Parkinson Disease/therapy , Depression/therapy , Depression/drug therapy , Quality of Life , Treatment Outcome
BACKGROUND: Minimally invasive surgery (MIS) for gastric cancer is increasingly performed. The purpose of this study is to evaluate trends in utilization of laparoscopic and robotic techniques compared to open surgery as well as utilization based on hospital volume. METHODS: We used the National Cancer Database to query patients who underwent gastrectomy from 2010 to 2017 for adenocarcinoma. Regression analyses were used to determine associations between MIS and clinical factors, the trend of MIS over time, and survival. RESULTS: A total of 18,380 patients met inclusion criteria. The annual rates of MIS increased for all hospital volumes, though lower volume centers were less likely to undergo MIS. MIS was associated with a shorter length of stay compared to open, and robotic gastrectomy had a higher rate of obtaining at least 15 lymph nodes and lower rate of having a positive margin. CONCLUSIONS: MIS utilization for resection of gastric cancer increased over time, with robotic surgery increasing at a higher rate than laparoscopic surgery. Importantly, this occurred without increased in mortality or sacrificing adequate oncologic outcomes.
Laparoscopy , Robotic Surgical Procedures , Robotics , Stomach Neoplasms , Humans , Stomach Neoplasms/pathology , Retrospective Studies , Robotic Surgical Procedures/methods , Gastrectomy/methods , Minimally Invasive Surgical Procedures/methods , Laparoscopy/methods , Length of Stay , Treatment Outcome
Here, we proposed a new strategy to build the integrated graphene cube (Gr) framework@TiO2 composite to improve the ion transport kinetics and electrical conductivity of TiO2 as a long-life and high-capacity anode for lithium ion batteries. Combined with the salt template method for ultra-thin framework, the distinct structure of Gr@TiO2 shows an excellent electrochemical performance, e.g., initial coulombic efficiency (ICE), rate performance and specific capacity, due to the increased kinetics of lithium ions. Through this method, the integrity is dramatically improved and the pulverization and agglomeration of the anode after long-term cycles are restrained. The optimized Gr@TiO2 displays a high stable reversible capacity of 179.5 mAh g-1 after 4000 cycles at 1 A g-1, excellent rate performance (125.5 mAh g-1 at 5 A g-1). Kinetic studies through Electrochemical Impedance Spectra, Galvanostatic Intermittent Titration Technique and Linear Sweep Voltammetry confirm that the electrical conductivity and ion transport kinetics are dramatically improved through the ultra-thin graphene cube framework as a heterojunction structure of Gr@TiO2.
For the high theoretical specific capacity and low redox potential, lithium (Li) metal is considered as one of the most promising anode materials for the next generation of rechargeable batteries. In this work, we have developed an effective and accurate plasma strategy to regulate the surface morphology and functional groups of three-dimensional nitrogen-containing carbon foam (CF) to control the Li nucleation and growth. Besides the rougher surface induced by oxygen (O2) plasma, the conversion of carbon-nitrogen chemical bond (CN), namely, change from the quaternary N to pyrrolic/pyridinic N was realized by the nitrogen (N2) plasma. This chemical regulation of nitrogen boosts the lithiophilicity of carbon foam, which is evidenced by lower overpotential obtained from the experiment and higher binding energy for Li ions (Li+) calculated by density functional theory (-1.43, -1.85, -2.41 and -2.45 eV for the amorphous C-, C-quaternary N-, C-pyrrolic N- and C-pyridinic N-, respectively). The electrochemical performance of the half cells and full cells based on this plasma regulated carbon foam collectors also proved the prominent effectiveness of this plasma strategy on guiding the uniform dispersion of Li+ and thus inducing the homogeneous Li nucleation, as well as suppressing the growth of Li dendrites.
Stable and efficient guided waves are essential for information transmission and processing. Recently, topological valley-contrasting materials in condensed matter systems have been revealed as promising infrastructures for guiding classical waves, for they can provide broadband, non-dispersive and reflection-free electromagnetic/mechanical wave transport with a high degree of freedom. In this work, by designing and manufacturing miniaturized phononic crystals on a semi-infinite substrate, we experimentally realized a valley-locked edge transport for surface acoustic waves (SAWs). Critically, original one-dimensional edge transports could be extended to quasi-two-dimensional ones by doping SAW Dirac "semimetal" layers at the boundaries. We demonstrate that SAWs in the extended topological valley-locked edges are robust against bending and wavelength-scaled defects. Also, this mechanism is configurable and robust depending on the doping, offering various on-chip acoustic manipulation, e.g., SAW routing, focusing, splitting, and converging, all flexible and high-flow. This work may promote future hybrid phononic circuits for acoustic information processing, sensing, and manipulation.
Despite their importance in tissue homeostasis and renewal, human pituitary stem cells (PSCs) are incompletely characterized. We describe a human single nucleus RNA-seq and ATAC-seq resource from pediatric, adult, and aged postmortem pituitaries (snpituitaryatlas.princeton.edu) and characterize cell-type-specific gene expression and chromatin accessibility programs for all major pituitary cell lineages. We identify uncommitted PSCs, committing progenitor cells, and sex differences. Pseudotime trajectory analysis indicates that early-life PSCs are distinct from the other age groups. Linear modeling of same-cell multiome data identifies regulatory domain accessibility sites and transcription factors that are significantly associated with gene expression in PSCs compared with other cell types and within PSCs. We identify distinct deterministic mechanisms that contribute to heterogeneous marker expression within PSCs. These findings characterize human stem cell lineages and reveal diverse mechanisms regulating key PSC genes and cell type identity.
Chromatin , Transcriptome , Aged , Child , Chromatin Immunoprecipitation Sequencing , Female , Humans , Male , Stem Cells/metabolism , Transcription Factors/metabolism , Transcriptome/genetics
BACKGROUND: Firework-related injuries cause significant morbidity to persons in the United States and globally. Prior studies have shown that hands and eyes are frequently injured, with loss of hand function and blindness being common after serious injury. Many jurisdictions in the United States have relaxed laws governing sales of consumer fireworks in recent years. Given the increased availability of consumer fireworks, we sought to determine the incidence of firework-related injuries compared with historical controls. METHODS: Firework-related injuries were identified in the National Emergency Department Sample (NEDS) using the corresponding International Classification of Disease codes for the years 2008-2017. Demographics, timing of presentation, and hospital characteristics were analyzed. Data were weighted to approximate population estimates of injury. Statistical analyses were completed using SAS. The National Electronic Surveillance System was also queried for firework-related visits to check for consistency in observed trends. RESULTS: There were an estimated 7699 injuries attributed to fireworks in 2017 (2.37 per 100,000 population) compared with 5727 (1.88 per 100,000 population) in 2008. The majority of victims were male (74.6%), and injuries clustered in the pediatric and young adult age groups. The Midwest and South (both 38.1%) had more firework-related injuries compared with the West (15.6%) and Northeast (8.2%) regions. Most visits occurred in July (71.4%) with smaller peaks in June (6.9%) and January (6.0%). Patients were disproportionately seen in trauma centers (34.0%) and teaching hospitals (49.6%). CONCLUSION: Emergency department visits for firework injuries are increasing in the United States. Pediatric patients and young adult males comprise the majority of victims. Injuries are clustered around the Fourth of July and New Year's holidays. Public health interventions targeted at high-risk groups may reduce the burden of injury.
Emerging studies have found long noncoding RNAs, widely expressed in eukaryotes, crucial regulators in the progression of human cancers, including hepatocellular carcinoma (HCC). Although the long intergenic noncoding RNA 667 (LINC00667) can promote the progression of a variety of cancer types, the expression pattern, the role in cancer progression, and the molecular mechanism involved in HCC remain unclear. This study aims to investigate the function and mechanism of LINC00667 in HCC progression. The effects of LINC00667 silencing in cell proliferation, cell migration, and cell invasion, and androgen receptor (AR) expression were determined with loss-of-function phenotypic analysis in Huh-7 and HCCLM3 cells, and subsequently testified in vivo in tumor growth. We found that the expression of LINC00667 was upregulated in HCC tissues and cell lines. Upregulation of LINC00667 was significantly associated with the unfavorable prognosis of HCC in our study patients. On the other hand, low expression of LINC00667 significantly inhibited the cell proliferation, cell migration and cell invasion of HCC in vitro and tumor growth in vivo. This inhibitory effect could be counteracted by miR-130a-3p inhibitor. LINC00667 reduced the inhibition of AR expression by miR-130a-3p, which correlated with the progression of HCC. Our finding suggests LINC00667 is a molecular sponge in the miR-130s-3p/AR signal pathway in the progression of HCC, in which it relieves the repressive function of miR-130a-3p on the AR expression. This indicates LINC00667 functions as a tumor promotor in promoting HCC progression through targeting miR-130a-3p/AR axis, making a novel biomarker and potential therapeutic target for HCC.
