Graduate anatomy education: How are we training the future generations of anatomy educators?

The teaching of anatomy is relevant to many fields and anatomy teachers are in demand. Individuals with a graduate anatomy education are some of the most sought-after candidates to fill open teaching positions, but it is unclear as to what constitutes a graduate anatomy education. The purpose of this study was to investigate the components of a graduate anatomy education in the United States. A survey regarding the components of doctoral, master's, and graduate certificate programs was distributed to program directors and department chairs at 71 US institutions. Respondents indicated that there were 17 doctoral, 28 master's, and 9 graduate certificate programs. Students completed coursework in all the traditional anatomical subdisciplines in approximately half of doctoral (53%) and master's (57%) programs, though the number was lower in graduate certificate programs (22%). In comparison, within 12 programs (5 doctoral, 4 master's, and 3 graduate certificate) students were required to complete coursework in less than 2 anatomical subdisciplines. Required coursework outside the subdisciplines usually involved educational theories and practices (61% of programs), research methods (52% of programs), and/or physiology (37% of programs). Respondents indicated that most programs (81%) were designed to prepare their students to teach. It appears that graduate anatomy training likely involves gross anatomy coursework, coursework in another anatomical subdiscipline, and coursework in educational theories and practices. Given the likely decline in the number of doctoral-level anatomy programs from 21 to 19, serious consideration should be given to hiring teaching candidates with master's or graduate certificate training in anatomy.

Influence of Encapsulation on the Efficiency and Positive Aging Behavior in Blue Quantum Dot Light-Emitting Devices.

Encapsulating blue quantum dot light-emitting devices (QLEDs) using an ultraviolet curable resin is known to lead to a significant increase in their efficiency. Some of this efficiency increase occurs immediately, whereas some of it proceeds over a period of time, typically over several tens of hours following the encapsulation, a behavior commonly referred to as positive aging. The root causes of this positive aging, especially in blue QLEDs, remain not well understood. Here, it is revealed that contrary to the expectation, the significant improvement in device efficiency during positive aging arises primarily from an improvement in electron injection across the QD/ZnMgO interface and not due to the inhibition of interface exciton quenching as is widely believed. The underlying changes are investigated by XPS measurements. Results show that the enhancement in device performance arises primarily from the reduction in O-related defects in both the QDs and ZnMgO at the QD/ZnMgO interface. After 51.5 h, the blue QLEDs reach the optimal performance, exhibiting an EQEmax of 12.58%, which is more than sevenfold higher than that in the control device without encapsulation. This work provides design principles for realizing high efficiency in blue QLEDs with oxide electron-transporting layers (ETLs) and provides a new understanding of the mechanisms underlying positive aging in these devices and thus offers a new starting point for both fundamental investigations and practical applications.

Inverted Solution-Processed Quantum Dot Light-Emitting Devices with Wide Band Gap Quantum Dot Interlayers.

Despite its benefits for facilitating device fabrication, utilization of a polymeric hole transport layer (HTL) in inverted quantum dots (QDs) light-emitting devices (IQLEDs) often leads to poor device performance. In this work, we find that the poor performance arises primarily from electron leakage, inefficient charge injection, and significant exciton quenching at the HTL interface in the inverted architecture and not due to solvent damage effects as is widely believed. We also find that using a layer of wider band gap QDs as an interlayer (IL) in between the HTL and the main QDs' emission material layer (EML) can facilitate hole injection, suppress electron leakage, and reduce exciton quenching, effectively mitigating the poor interface effects and resulting in high electroluminescence performance. Using an IL in IQLEDs with a solution-processed poly(9,9-dioctylfluorene-alt-N-(4-sec-butylphenyl)-diphenylamine) (TFB), HTL improves the efficiency by 2.85× (from 3 to 8.56%) and prolongs the lifetime by 9.4× (from 1266 to 11,950 h at 100 cd/m2), which, to the best of our knowledge, is the longest lifetime for an R-IQLED with a solution-coated HTL. Measurements on single-carrier devices reveal that while electron injection becomes easier as the band gap of the QDs decreases, hole injection surprisingly becomes more difficult, indicating that EMLs of QLEDs are more electron-rich in the case of red devices and more hole-rich in the case of blue devices. Ultraviolet photoelectron spectroscopy measurements verify that blue QDs have a shallower valence band energy than their red counterparts, corroborating these conclusions. The findings in this work, therefore, provide not only a simple approach for achieving high performance in IQLEDs with solution-coated HTLs but also novel insights into charge injection and its dependence on QDs' band gap as well as into different HTL interface properties of the inverted versus upright architecture.

Change in Financial Stress and Relational Wellbeing During COVID-19: Exacerbating and Alleviating Influences.

Guided by the family adjustment and adaptation response (FAAR) model and using a panel survey of 1510 adults in the US administered during the summer of 2020 and a mixed methods approach, we explored associations between changes in financial stress related to COVID-19 and relational wellbeing. Regression analyses showed that, compared to those who maintained their levels of financial stress, those who reported increased financial stress reported increased conflict and those who reported decreased financial stress reported decreased conflict. However, decreased financial stress was also associated with decreases in emotional closeness and relationship happiness, suggesting that changes in financial stress can lead to both maladaptation and bonadaptation in families. Qualitative findings provide insights into factors that may exacerbate or help alleviate financial stress related to COVID-19.

Epidemiology of pediatric cartilage restoration procedures in the United States: insurance and geography play a role.

OBJECTIVES: The purpose of this study is to analyze the epidemiology of children and adolescents undergoing osteochondral autograft transplantation (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI) in the United States. METHODS: The Pediatric Health Information System, a national database consisting of 49 children's hospitals, was queried for all patients undergoing OAT, OCA, and ACI between 2012 and 2018. Demographic information was collected for each subject. United States Census guidelines were used to categorize hospitals geographically. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. RESULTS: A total of 809 subjects with a mean age of 15.4 ± 2.4 years were included in the analysis. Of these, 48.6% underwent OCA, 41.9% underwent OAT, and 9.5% underwent ACI. After adjusting for confounders in a multivariate model, ACI was 3.6 times more likely to be performed in patients with private insurance than those that were publicly insured (95% CI 1.6-8.0, p = 0.002). Furthermore, a patient in the Northeast was 33.1 times more likely to undergo ACI than in the West (95% CI 4.5-246.1, p = 0.001). OAT was performed most frequently in the West and Midwest (52.4% and 51.8% of the time, respectively; p < 0.001). CONCLUSION: In the United States, there is substantial variation in the procedures performed for cartilage restoration in children and adolescents. Though ACI is the least commonly selected operation overall, it is significantly more likely to be performed on patients with private insurance and those in the Northeast.

Is Preferred Language Other Than English Associated With Delayed Surgery After ACL Injury in Children and Adolescents?

BACKGROUND: Previous studies have investigated the impact of social determinants of health, such as the type of healthcare insurance and household income, on children and adolescents with ACL tears. However, despite the increasing incidence of ACL injury in young patients and a substantial proportion of families who may prefer languages other than English, the relationship between language and clinical care remains unclear. QUESTIONS/PURPOSES: To investigate the relationship between language and the care of children and adolescents with ACL tears, we asked: (1) Is a preferred language other than English (PLOE) associated with a delay between ACL injury and surgery? (2) Is a PLOE associated with a greater odds of a patient experiencing a meniscal tear and undergoing a meniscectomy than in those who prefer English? METHODS: We treated 591 patients surgically for ACL injuries between 2011 and 2021. Of those, we considered patients aged 18 years or younger who underwent primary ACL reconstruction for this retrospective, comparative study. Five percent (31 of 591) of patients were excluded because the date of injury was not clearly documented, 2% (11 of 591) were revision reconstructions, and 1% (6 of 591) underwent procedures that were intentionally delayed or staged, leaving 92% (543 of 591) for analysis. The mean age was 16 ± 2 years, and 51% (276 of 543) of patients were boys. The family's preferred language was noted, as were demographic data, time between injury and surgery, and intraoperative findings. A language other than English was preferred by 21% (113 of 543) of patients. Of these, 94% (106 of 113) preferred Spanish. In a univariate analysis, we used independent-samples t-tests, Mann-Whitney U-tests, and Fisher exact tests, as appropriate. Purposeful-entry multivariable regression analyses were used to determine whether PLOE was associated with increased time to surgery, concomitant meniscus injury, or performance of meniscectomy while adjusting for confounding variables. Variables were included in multivariable models if they met the threshold for statistical significance in univariate testing (p < 0.05). RESULTS: The median time between injury and ACL reconstruction was shorter in families who preferred English compared with those with a PLOE (69 days [IQR 80] versus 103 days [IQR 107)]; p < 0.001). After controlling for potentially confounding variables like insurance and age, we found that patients whose families had a PLOE had greater odds of undergoing surgery more than 60 days after injury (OR 2.2 [95% CI 1.3 to 3.8]; p = 0.005) and more than 90 days after injury (OR 1.8 [95% CI 1.1 to 2.8]; p = 0.02). After controlling for insurance, age, and other factors, PLOE was not associated with surgical delay beyond 180 days, concomitant meniscal tears, or performance of meniscectomy. CONCLUSION: In this study of children and adolescents undergoing primary ACL reconstruction, patients whose families prefer a language other than English experienced a longer delay between injury and surgery. In areas with a large proportion of families with a PLOE, partnerships with primary care clinicians, emergency departments, schools, athletic teams, and community organizations may improve efficiency in the care of children with ACL injuries. Clinicians proficient in other languages, reliable interpreter services, and translated references and resources may also be impactful. Our results suggest a need for further research on the experiences, needs, and long-term outcomes of these patients, as well as the association of preferred language with results after surgery. LEVEL OF EVIDENCE: Level III, therapeutic study.

Are Neighborhood Conditions Associated With Surgical Delays and Meniscus Tears in Children and Adolescents Undergoing ACL Reconstruction?

BACKGROUND: Markers of a patient's social determinants of health, including healthcare insurance and median household income based on ZIP Code, have been associated with the interval between injury and ACL reconstruction (ACLR) as well as the presence of concomitant meniscus tears in children and adolescents. However, the aforementioned surrogate indicators of a patient's social determinants of health may not reflect all socioeconomic and healthcare resources affecting the care of ACL injuries in children and adolescents. The use of multivariate indices such as the Child Opportunity Index (COI) may help to better identify patients at risk for increased risk for delay between ACL injury and surgery, as well as the incidence of meniscus tears at the time of surgery. The COI is a summative measure of 29 indicators that reflect neighborhood opportunities across three domains: education, health and environment, and social and economic factors. COI scores range from 0 to 100 (100 being the highest possible score), as well as five categorical scores (very low, low, moderate, high, and very high) based on quintile rankings. QUESTIONS/PURPOSES: To investigate the relationship between neighborhood conditions and the treatment of ACL injuries in children and adolescents via the COI, we asked: (1) Is a lower COI score associated with a longer delay between ACL injury and surgery? (2) Does a higher proportion of patients with lower COI scores have meniscus tears at the time of ACLR? METHODS: In this retrospective, comparative study, we considered data from 565 patients, 18 years or younger, who underwent primary ACLR at an urban, tertiary children's hospital between 2011 and 2021. Of these patients, 5% (31 of 565) did not have a clearly documented date of injury, 2% (11 of 565) underwent revision reconstructions, and 1% (5 of 565) underwent intentionally delayed or staged procedures. Because we specifically sought to compare patients who had low or very low COI scores (lowest two quintiles) with those who had high or very high scores (highest two quintiles), we excluded 18% (103 of 565) of patients with moderate scores. Ultimately, 73% (415 of 565) of patients with COI scores in either the top or bottom two quintiles were included. Patient addresses at the time of surgery were used to determine the COI score. There were no differences between the groups in terms of gender. However, patients with high or very high COI scores had a lower median (IQR) age (15 years [2.6] versus 17 years [1.8]; p < 0.001) and BMI (23 kg/m 2 [6.1] versus 25 kg/m 2 [8.8]; p < 0.001), were more commonly privately insured (62% [117 of 188] versus 22% [51 of 227]; p < 0.001), and had a higher proportion of patients identifying as White (67% [126 of 188] versus 6.2% [14 of 227]; p < 0.001) compared with patients with low or very low COI scores. Medical records were reviewed for demographic, preoperative, and intraoperative data. Univariate analyses focused on the relationship of the COI and interval between injury and surgery, frequency of concomitant meniscus tears, and frequency of irreparable meniscus tears treated with partial meniscectomy. Multivariable regression analyses were used to determine factors that were independently associated with delayed surgery (longer than 60 and 90 days after injury), presence of concomitant meniscal injuries, and performance of meniscectomy. Multivariable models included insurance and race or ethnicity to determine whether COI was independently associative after accounting for these variables. RESULTS: Patients with a high or very high COI score had surgery earlier than those with a low or very low COI score (median [IQR] 53 days [53] versus 97 days [104]; p < 0.001). After adjusting for insurance and race/ethnicity, we found that patients with a low or very low COI score were more likely than patients with a high or very high COI score to have surgery more than 60 days after injury (OR 2.1 [95% CI 1.1 to 4.0]; p = 0.02) or more than 90 days after injury (OR 1.8 [95% CI 1.1 to 3.4]; p = 0.04). Furthermore, patients with low or very low COI scores were more likely to have concomitant meniscus tears (OR 1.6 [95% CI 1.1 to 2.5]; p = 0.04) compared with patients with high or very high COI scores. After controlling for insurance, race/ethnicity, time to surgery, and other variables, there was no association between COI and meniscectomy (OR 1.6 [95% CI 0.9 to 2.8]; p = 0.12) or presence of a chondral injury (OR 1.7 [95% CI 0.7 to 3.9]; p = 0.20). CONCLUSION: As the COI score is independently associated with a delay between ACL injury and surgery as well as the incidence of meniscus tears at the time of surgery, this score can be useful in identifying patients and communities at risk for disparate care after ACL injury. The COI score or similar metrics can be incorporated into medical records to identify at-risk patients and dedicate appropriate resources for efficient care. Additionally, neighborhoods with a low COI score may benefit from improvements in the availability of additional and/or improved resources. Future studies should focus on the relationship between the COI score and long-term patient-reported functional outcomes after ACL injury, identification of the specific timepoints in care that lead to delayed surgery for those with lower COI scores, and the impact of community-based interventions in improving health equity in children with ACL injury. LEVEL OF EVIDENCE: Level III, therapeutic study.

Significant Lifetime Enhancement in QLEDs by Reducing Interfacial Charge Accumulation via Fluorine Incorporation in the ZnO Electron Transport Layer.

ZnO nanoparticles are widely used for the electron transport layers (ETLs) of quantum dots light emitting devices (QLEDs). In this work we show that incorporating fluorine (F) into the ZnO ETL results in significant enhancement in device electroluminescence stability, leading to LT50 at 100 cd m-2 of 2,370,000 h in red QLED, 47X longer than the control devices. X-ray photo-electron spectroscopy, time-of-flight secondary ion mass spectroscopy, photoluminescence and electrical measurements show that the F passivates oxygen vacancies and reduces electron traps in ZnO. Transient photoluminescence versus bias measurements and capacitance-voltage-luminance measurements reveal that the CF4 plasma-treated ETLs lead to increased electron concentration in the QD and the QD/hole transport layer interface, subsequently decreasing hole accumulation, and hence the higher stability. The findings provide new insights into the critical roles that optimizing charge distribution across the layers play in influencing stability and present a novel and simple approach for extending QLED lifetimes.

Reoperation After Osteochondral Autograft and Allograft Transfer in the Pediatric Knee.

Osteochondral autograft (OAU) transfer and osteochondral allograft (OAL) transfer are options for treating sizable articular cartilage lesions in the knee, but there is little evidence to support one technique over another. The goal of this study is to compare the rate of reoperation among children and adolescents undergoing OAU or OAL of the knee. In this retrospective cohort study, the Pediatric Health Information System, a national database consisting of 49 children's hospitals, was queried for all patients undergoing OAU and OAL between 2012 and 2018. A total of 732 subjects with a mean age of 15.4±2.4 years were included. Of these, 393 (53.7%) initially underwent OAL and 339 (46.3%) underwent OAU. The overall reoperation rate was 144 of 732 (19.7%) at a median of 6.6 months (range, 0.6-53.5 months) after the index operation. This rate was similar for OAL and OAU. For 18 subjects (2.5%), OAU, OAL, or autologous chondrocyte implantation (ACI) was performed at the time of revision surgery. When analyzing only open procedures, we found that the reoperation rate was 25.5% for open OAU compared with 16.5% for open OAL (P=.03). When adjusting for covariates in multivariate regression, we found that those who underwent open OAU had 1.7 times higher odds of requiring a future reoperation than those who underwent open OAL (95% CI, 1.1-2.8; P=.04). Although the rate of reoperation after OAU or OAL among children and adolescents is relatively high, few require revision OAU, OAL, or ACI. Patients undergoing open OAU have higher odds of ultimately requiring reoperation than those undergoing open OAL. [Orthopedics. 2022;45(6):378-383.].

Targeting uPA-uPAR interaction to improve intestinal epithelial barrier integrity in inflammatory bowel disease.

BACKGROUND: Loss of intestinal epithelial barrier integrity is a critical component of Inflammatory Bowel Disease (IBD) pathogenesis. Co-expression regulation of ligand-receptor pairs in IBD mucosa has not been systematically studied. Targeting ligand-receptor pairs which are induced in IBD mucosa and function in intestinal epithelial barrier integrity may provide novel therapeutics for IBD. METHODS: We performed transcriptomic meta-analysis on public IBD datasets combined with cell surface protein-protein-interaction (PPI) databases. We explored primary human/mouse intestinal organoids and Caco-2 cells for expression and function studies of uPA-uPAR (prime hits from the meta-analysis). Epithelial barrier integrity was measured by Trans-Epithelial Electrical Resistance (TEER), FITC-Dextran permeability and tight junction assessment. Genetic (CRISPR, siRNA and KO mice) and pharmacological (small molecules, neutralizing antibody and peptide inhibitors) approaches were applied. Mice deficient of uPAR were studied using the Dextran Sulfate Sodium (DSS)-induced colitis model. FINDINGS: The IBD ligand-receptor meta-analysis led to the discovery of a coordinated upregulation of uPA and uPAR in IBD mucosa. Both genes were significantly upregulated during epithelial barrier breakdown in primary intestinal organoids and decreased during barrier formation. Genetic inhibition of uPAR or uPA, or pharmacologically blocking uPA-uPAR interaction protects against cytokine-induced barrier breakdown. Deficiency of uPAR in epithelial cells leads to enhanced EGF/EGFR signalling, a known regulator of epithelial homeostasis and repair. Mice deficient of uPAR display improved intestinal barrier function in vitro and during DSS-induced colitis in vivo. INTERPRETATION: Our findings suggest that blocking uPA-uPAR interaction via pharmacological agents protects the epithelial barrier from inflammation-induced damage, indicating a potential therapeutic target for IBD. FUNDING: The study was funded by Boehringer Ingelheim.

Predictors of Arthrofibrosis After Pediatric Anterior Cruciate Ligament Reconstruction: What Is the Impact of Quadriceps Autograft?

BACKGROUND: Recent literature on arthrofibrosis after anterior cruciate ligament reconstruction (ACLR) in children and adolescents is limited, especially with regards to quadriceps tendon (QT) autograft. The purpose of this study was to identify predictors of arthrofibrosis after ACLR, with attention to the impact of graft type. METHODS: Patients that underwent primary ACLR at a tertiary children's hospital were reviewed for this retrospective case-control study. Those with multiligament reconstructions, lateral extra-articular tenodesis procedures, allografts, or a modified MacIntosh reconstruction were excluded. Arthrofibrosis was defined as a deficit of 10 degrees of extension and/or 20 degrees of flexion at 3 months after ACLR. Univariate analysis was followed by purposeful entry logistic regression to adjust for confounding factors. RESULTS: A total of 378 patients (mean age 15.9±1.7 y, 49.7% female) were included in the analysis, of which there were 180 patellar tendon (PT), 103 hamstrings tendon (HT), and 95 QT grafts. The rate of arthrofibrosis was 1.9% for HT, 6.3% for QT, and 10.0% for PT (P=0.04). Females developed arthrofibrosis more frequently than males (10.6% vs. 3.2%, P=0.004). Those that ultimately experienced this complication had lower median flexion at 6 weeks after ACLR (88 vs. 110 degrees, P<0.001). In multivariate analysis, PT graft raised the odds of arthrofibrosis 6.2 times compared to HT [95% confidence interval (CI): 1.4-27.6, P=0.02], but there were no significant differences between QT and other grafts. Females were at 4.2 times higher odds than males (95% CI: 1.6-10.8; P=0.003). Patients that were unable to attain 90 degrees of flexion 6 weeks after ACLR had 14.7 times higher odds of eventually developing arthrofibrosis (95% CI: 5.4-39.8; P<0.001). Finally, those with an extension deficit of ≥5 degrees 6 weeks after ACLR had 4.7 times higher odds of experiencing this complication (95% CI: 1.8-12.2, P=0.001). CONCLUSION: The rate of arthrofibrosis with QT autograft is 6.3% after pediatric ACLR. PT autograft, female sex, and motion deficits at 6 weeks after ACLR were predictive of arthrofibrosis in children and adolescents. LEVEL OF EVIDENCE: Level III-prognostic study.

Significant enhancement in quantum-dot light emitting device stability via a ZnO:polyethylenimine mixture in the electron transport layer.

The effect of adding polyethylenimine (PEI) into the ZnO electron transport layer (ETL) of inverted quantum dot (QD) light emitting devices (QDLEDs) to form a blended ZnO:PEI ETL instead of using it in a separate layer in a bilayer ZnO/PEI ETL is investigated. Results show that while both ZnO/PEI bilayer ETL and ZnO:PEI blended ETL can improve device efficiency by more than 50% compared to QDLEDs with only ZnO, the ZnO:PEI ETL significantly improves device stability, leading to more than 10 times longer device lifetime. Investigations using devices with marking luminescent layers, electron-only devices and delayed electroluminescence measurements show that the ZnO:PEI ETL leads to a deeper penetration of electrons into the hole transport layer (HTL) of the QDLEDs. The results suggest that the stability enhancement may be due to a consequent reduction in hole accumulation at the QD/HTL interface. The findings show that ZnO:PEI ETLs can be used for enhancing both the efficiency and stability of QDLEDs. They also provide new insights into the importance of managing charge distribution in the charge transport layers for realizing high stability QDLEDs and new approaches to achieve that.

Laparoscopic repair of recurrent inguinal hernia offers similar outcomes and quality of life to primary laparoscopic repair.

OBJECTIVE: Open repair of recurrent inguinal hernias has been shown to result in significantly poorer perioperative outcomes when compared to open primary hernia repair. However, limited data exist comparing primary and recurrent laparoscopic inguinal hernia repair (LIHR). The aim of our study was to compare quality of life and clinical outcomes between these two groups. METHODS: Patients undergoing LIHR at a single institution from 2012 to 2018 were reviewed from a prospectively managed quality database. Quality of life outcomes were measured using the surgical outcomes measurement system and Carolinas Comfort Scale surveys administered preoperatively and at 3 weeks, 6 months, 1 year, and 2 years postoperatively. RESULTS: A total of 1298 patients undergoing LIHR were analyzed (1139 primary, 159 recurrent). There were older and more male patients in the recurrent group. There were no major complications, and recurrence rates were not significantly different between primary and recurrent groups (1.3% vs 2.4% p = 0.56), while hematoma occurred more commonly in the recurrent group (1.5% vs 4.4% p = 0.0205). Short- and long-term quality of life were similar between the groups except lower (worse) physical function at 3 weeks (32.9 ± 4.2 vs 31.9 ± 4.4: p = 0.0186) and 6 months (34.6 ± 2.8 vs 33.8 ± 3.0: p = 0.0175) and increased sensation of mesh (3 weeks) in the recurrent group (2.3 ± 5.4 vs 3.3 ± 5.3: p = 0.0160). CONCLUSION: Recurrent inguinal hernia repair using laparoscopic totally extraperitoneal approach is as safe and effective as primary repair with similar quality of life.

Significant Enhancement in Quantum Dot Light-Emitting Device Stability via a Cascading Hole Transport Layer.

This work investigates the effect of the hole transport layer (HTL) on the stability of electroluminescent quantum dot light-emitting devices (QDLEDs). The electroluminescence half-life (LT50) of QDLEDs can be improved by 25× through the utilization of a cascading HTL (CHTL) structure with consecutive steps in the highest occupied molecular orbital energy level. Using this approach, a LT50 of 864,000 h (for an initial luminance of 100 cd m-2) is obtained for red QDLEDs using a conventional core/shell QD emitter. The CHTL primarily improves QDLED stability by shifting excessive hole accumulation away from the QD/HTL interface and toward the interlayer HTL/HTL interfaces. The wider electron-hole recombination zone in the CHTL for electrons that have leaked from the QD layer results in less HTL degradation at the QD/HTL interface. This work highlights the significant influence of the HTL on QDLED stability and represents the longest LT50 for a QDLED based on the conventional core/shell QD structure.

The role of excitons within the hole transporting layer in quantum dot light emitting device degradation.

This work investigates the root causes of the limited stability of electroluminescent quantum dot light-emitting devices (QDLEDs). Studies using electrical measurements, continuous UV irradiation, and both steady-state and transient photoluminescence (PL) spectroscopy reveal that exciton-induced degradation of the hole transporting material (HTM) in QDLEDs plays a role in limiting their electroluminescence (EL) stability. The results indicate that there is a correlation between device EL stability and the susceptibility of the HTM to exciton-induced degradation. The presence of quenchers in the HTM layer can lead to a decrease in the luminescence quantum yield of QDs, suggesting that energy transfer between the QD and HTM films may play a role in this behavior. The results uncover a new degradation mechanism where excitons within the HTM limit the EL stability of QDLEDs.

Patient-Centered Outcomes after Laparoscopic Paraesophageal Hernia Repair.

BACKGROUND: The aim of this study is to investigate patient-centered quality of life (QOL) outcomes in patients undergoing laparoscopic paraesophageal hernia repair. STUDY DESIGN: We prospectively followed patients who underwent laparoscopic paraesophageal hernia repair between 2009 and 2016. The QOL outcomes were measured using the 36-Item Short Form Health Survey, GERD Health Related Quality of Life, Reflux Symptom Index, and Dysphagia score surveys administered preoperatively and at 3 weeks, 6 months, 1 year, and 2 years postoperatively. Postoperative QOL outcomes were compared with preoperative baseline scores using paired t-tests. RESULTS: Of 314 total patients who underwent laparoscopic paraesophageal hernia repair, 188 with adequate follow-up were included in analysis. Mean age was 69.1 ± 11.8 years and 22.3% of studied subjects were male. Most of the cohort also underwent laparoscopic fundoplication (95.7%). Prevalent symptoms at initial presentation include heartburn (65.4%) and regurgitation (60.1%). Significant improvements between baseline and all postoperative time points were seen in Reflux Symptoms Index (3 weeks: p < 0.0001, 6 months: p = 0.005, 1 year: p = 0.0004, and 2 years: p = 0.002) and GERD Health Related Quality of Life scores (3 weeks: p < 0.0001, 6 months: p = 0.0019, 1 year: p < 0.0001, and 2 years: p = 0.0003). Dysphagia scores were worse at 3 weeks but lost significance at all other time points. The 36-Item Short Form Health Survey measures of Energy/Fatigue (p = 0.0099), Emotional Well-Being (p = 0.0393), Social Functioning (p = 0.0278), Pain (p = 0.0021), and Role Limitations Due to Physical Health (p = 0.0009) were significantly improved 2 years postoperatively. CONCLUSIONS: Laparoscopic paraesophageal hernia repair results in significantly improved QOL as measured by the 36-Item Short Form Health Survey at both short- and long-term intervals. Additionally, Reflux Symptom Index and GERD Health Related Quality of Life scores improved at all postoperative time points.

The role of polyethylenimine in enhancing the efficiency of quantum dot light-emitting devices.

Although the use of polyethylenimine (PEI) in quantum dot light-emitting devices (QDLEDs) has recently been found to improve efficiency, the mechanism behind this increase has been disputed in the literature. In this work, we conduct investigations to elucidate the role of PEI in enhancing QDLED efficiency. Spectroscopic studies of devices with a phosphorescent marking layer reveal that the PEI layer increases, rather than decreases, the generation of excitons within the hole transporting layer indicative of increased electron injection. Delayed electroluminescence measurements corroborate these findings as devices with a PEI interlayer exhibit a greater concentration of excess mobile and trapped electrons. We attribute the improvement in efficiency despite the ensuing increased charge imbalance within the devices to the passivation of exciton quenching at the ZnO/QD interface. The increase in efficiency predominantly occurs over low driving currents which is particularly attractive for the brightness targets of display applications. Furthermore, despite the increased charge imbalance, the PEI passivation layer appears to have little effect on QDLED stability. This shows that excess electrons and Auger quenching by unneutralized electrons are not detrimental to QDLED stability.

Quality of life after laparoscopic totally extraperitoneal repair of an asymptomatic inguinal hernia.

BACKGROUND: When considering an asymptomatic inguinal hernia, surgeons must weigh the risks of watchful waiting against the risk of operative complications. Laparoscopy offers the benefit of reduced postoperative pain, which, for appropriate surgical candidates, may strengthen the case for repair. This study compares general and disease-specific quality of life following totally extraperitoneal (TEP) laparoscopic inguinal hernia repair (LIHR) of asymptomatic and symptomatic hernias. METHODS: We summarize prospective data from 387 patients who underwent TEP LIHR between 2009 and 2015 by four surgeons at a single institution. Asymptomatic individuals were identified by pain scores of zero at preoperative clinic visits. Validated quality of life (QOL) measurements were administered preoperatively and at 3 weeks, 6 months, and 1-year postop. Comparisons were made using Chi-square test, t test, or Mann-Whitney U test. Changes over time were assessed using longitudinal mixed effects models. RESULTS: A cohort of 79 asymptomatic cases were compared to 308 symptomatic individuals. The asymptomatic cohort had larger median hernia defects (2.5 vs 2 cm, p < 0.01), was older (mean 63.0 vs 58.9 years, p = 0.03), included fewer indirect hernias (57.7 vs 74.9%, p < 0.01), took pain medication for fewer days (mean 1.2 ± 1.5 vs 2.2 ± 3.0 days, p = 0.02), returned to baseline activities of daily living earlier (median 3 vs 5 days, p < 0.01), and reported decreased postoperative pain (p = 0.02). There was no significant difference in general QOL. There was one recurrence in the asymptomatic group and were two in the symptomatic cohort. CONCLUSIONS: Asymptomatic individuals undergoing TEP LIHR reported less postoperative pain, returned to baseline activities, and discontinued pain medication sooner than symptomatic patients. These results are encouraging and may inform patient-centered discussions about asymptomatic hernia repair.

Metoclopramide for Acute Migraine Treatment in the Emergency Department: An Effective Alternative to Opioids.

In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings. Our literature review demonstrates that metoclopramide should be used more frequently as first-line therapy for an acute migraine over opioids. The use of opioids specifically has been discouraged as migraine treatment by the American Headache Society citing "insufficient evidence" as the main reason. Metoclopramide, specifically using the 10 mg dose, has been cited as "highly likely to be effective" by the same guidelines. Another major issue with opioids is the growing potential for abuse, thus minimizing the use of these drugs for only special circumstances would be beneficial overall.

Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis.

BACKGROUND: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient's decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools. METHODS: Patients undergoing laparoscopic totally extra-peritoneal inguinal hernia repair were identified from a prospectively maintained database. Short form-36, Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1 and 2 years. Patients with concomitant procedures were excluded. Significant pain was considered mild but bothersome or worse on either specific tool (SOMS scores ≥3/4, CCS scores ≥2). Predictors of significant pain were determined by logistic regression. RESULTS: From 2009 to 2015, 482 patients enrolled in our database underwent elective TEP repair of 626 hernias and completed an assessment tool. Mean age was 57 (±15) years, with 93 % male. Reported pain on all three tools improved significantly from baseline over time (p < 0.01). Significant pain on either specific tool, related or unrelated to surgery, was reported by 52 % of respondents (158/301) preoperatively, and postoperatively by 50 % at 3 weeks (111/220), 21 % at 6 months (15/70), 13 % at 1 year (14/108), and 25 % at 2 years (30/121). Significant pain at 6 months-2 years correlated more significantly with general health status than surgical factors. CONCLUSIONS: Significant pain can be as high as 50 % at 3 weeks on surgery-specific quality of life measures, but with significant improvement by 6 months which is maintained through 2 years. Poor quality of life and general health were the main predictors of pain after 6 months.