Composition-tunable transition metal dichalcogenide nanosheets via a scalable, solution-processable method.

The alloying of two-dimensional (2D) transition metal dichalcogenides (TMDs) is an established route to produce robust semiconductors with continuously tunable optoelectronic properties. However, typically reported methods for fabricating alloyed 2D TMD nanosheets are not suitable for the inexpensive, scalable production of large-area (m2) devices. Herein we describe a general method to afford large quantities of compositionally-tunable 2D TMD nanosheets using commercially available powders and liquid-phase exfoliation. Beginning with Mo(1-x)WxS2 nanosheets, we demonstrate tunable optoelectronic properties as a function of composition. We extend this method to produce Mo0.5W0.5Se2 MoSSe, WSSe, and quaternary Mo0.5W0.5SSe nanosheets. High-resolution scanning transmission electron microscopy (STEM) imaging confirms the atomic arrangement of the nanosheets, while an array of spectroscopic techniques is used to characterize the chemical and optoelectronic properties. This transversal method represents an important step towards upscaling tailored TMD nanosheets with a broad range of tunable optoelectronic properties for large-area devices.

Resilient managed competition during pandemics: lessons from the Italian experience.

One of the main governance decisions that policymakers need to make is whether to implement public services via centralized or decentralized forms. As Costa et al. discuss in their article, when public services are implemented via competing systems, service providers contend to provide good services with the ultimate objective of gaining market quota. This is known as managed competition (MC), as the authorities will have to manage the panoply of public and private organizations offering the service. The alternative is to manage the service more centrally, in what it is identified as vertical integration. As the authors describe, several governments around the globe have abandoned their vertical integrated models in favour of decentralized models. This is the case, as the authors recall, for most health services in Europe. While there is an emerging body of evidence suggesting that decentralized MC outperforms vertically integrated models both in terms of efficiency and in terms of service quality, little is known on how these systems react under different circumstances. This means, for example, how these systems can cope with a sudden increase in their service demands.

Measuring leadership an assessment of the Multifactor Leadership Questionnaire.

Although the most used measure of transformational leadership, the Multifactor Leadership Questionnaire (MLQ), has been the subject of intense scrutiny among leadership scholars, little interest has been shown in analyzing the relationship between its underlying constructs and / or their measures. The present study identifies a formative factor structure for most MLQ first-order factors, replacing the usual reflective model. We demonstrate the value of this structure using data from two different samples. First, we applied the MLQ to a sample of 129 police officers from the Catalan Police workforce. Second, we ran an online survey with 300 US citizens. We argue that three second-order factors (transformational, transactional, and laissez faire) should be used as emergent aggregate multidimensional models to describe three different leadership styles, challenging the ubiquitous multidimensional latent models favored in the extant literature. We then propose that transformational/charismatic leadership should be treated as a multidimensional emergent profile model, replacing the leadership development order of precedence, which is dominant in modern leadership research.

Artificial intelligence for the public sector: opportunities and challenges of cross-sector collaboration.

Public sector organizations are increasingly interested in using data science and artificial intelligence capabilities to deliver policy and generate efficiencies in high-uncertainty environments. The long-term success of data science and artificial intelligence (AI) in the public sector relies on effectively embedding it into delivery solutions for policy implementation. However, governments cannot do this integration of AI into public service delivery on their own. The UK Government Industrial Strategy is clear that delivering on the AI grand challenge requires collaboration between universities and the public and private sectors. This cross-sectoral collaborative approach is the norm in applied AI centres of excellence around the world. Despite their popularity, cross-sector collaborations entail serious management challenges that hinder their success. In this article we discuss the opportunities for and challenges of AI for the public sector. Finally, we propose a series of strategies to successfully manage these cross-sectoral collaborations.This article is part of a discussion meeting issue 'The growing ubiquity of algorithms in society: implications, impacts and innovations'.

DETERMINANTS OF NETWORK OUTCOMES: THE IMPACT OF MANAGEMENT STRATEGIES.

The literature on network management is extensive. However, it generally explores network structures, neglecting the impact of management strategies. In this article we assess the effect of management strategies on network outcomes, providing empirical evidence from 119 urban revitalization networks. We go beyond current work by testing a path model for the determinants of network outcomes and considering the interactions between the constructs: management strategies, trust, complexity, and facilitative leadership. Our results suggest that management strategies have a strong effect on network outcomes and that they enhance the level of trust. We also found that facilitative leadership has a positive impact on network management as well as on trust in the network. Our findings also show that complexity has a negative impact on trust. A key finding of our research is that managers may wield more influence on network dynamics than previously theorized.

Adducted vocal cords relieved by neuromuscular blocking drug: a cause of impaired mechanical ventilation when using a laryngeal mask airway: two photographically documented cases.

Two cases of vocal cord closure, which was responsible for acute intraoperative impairment of mechanical ventilation in two patients with entropy-controlled depth of anesthesia, are reported. Administration of low-dose neuromuscular blocking drug was associated with immediate vocal cord relaxation and restoration of efficient mechanical ventilation.

Preventing biofilm formation and associated occlusion by biomimetic glycocalyxlike polymer in central venous catheters.

The use of catheters and other implanted devices is constantly increasing in modern medicine. Although catheters improve patients' healthcare, the hydrophobic nature of their surface material promotes protein adsorption and cell adhesion. Catheters are therefore prone to complications, such as colonization by bacterial and fungal biofilms, associated infections, and thrombosis. Here we describe the in vivo efficacy of biologically inspired glycocalyxlike antiadhesive coatings to inhibit Staphylococcus aureus and Pseudomonas aeruginosa colonization on commercial totally implantable venous access ports (TIVAPs) in a clinically relevant rat model of biofilm infection. Although noncoated TIVAPs implanted in rats were heavily colonized by the 2 biofilm-forming pathogens with a high percentage of occlusion, coating TIVAPs reduced their initial adherence and subsequently led to 4-log reduction in biofilm formation and reduced occlusion. Our antiadhesive approach is a simple and generalizable strategy that could be used to minimize clinical complications associated with the use of implantable medical devices.

La generación de innovación a través de la colaboración público-privada / The creation of innovation through public-private collaboration

En este artículo se desarrolla la idea de cómo las distintas opciones colaborativas público-privadas implementadas por las organizaciones afectan a la generación de innovación a través de un estudio de caso: el del Banco de Sangre y Tejidos. Los datos se obtuvieron mediante entrevistas en profundidad y semiestructuradas a todo el equipo directivo de la organización analizada. Se codificaron las entrevistas y se realizó un análisis de contenidos. Esta información se trianguló con la revisión de documentos internos de la organización. Este artículo contribuye a generar conocimiento sobre la gestión de la innovación en colaboraciones público-privadas en salud identificando la existencia de distintas opciones en una organización para desarrollar innovación colaborativa entre los sectores público y privado: contratación, partenariados público-privados contractuales y partenariados institucionalizados. Se constata que la generación de innovación está directamente relacionada con el acuerdo institucional escogido para desarrollar cada proyecto, de modo que determinadas innovaciones no son posibles sin un grado elevado de madurez en la colaboración interorganizativa. Sin embargo, también cabe destacar que, a medida que la intensidad de la colaboración se incrementa, los costes también, y el control del proceso disminuye (AU)

This article develops the notion of how different options of public-private collaborations implemented by organizations affect the creation of innovation through a case study: the Blood and Tissue Bank. Data were obtained through in-depth semi-structured interviews with the entire managerial team of the organization under analysis. We coded the interviews, and implemented content analysis. These data were triangulated with the analysis of the organization's internal documents. This article contributes to the understanding of innovation management in public-private collaborations in health professions by identifying the existence of different options in an organization to develop collaborative innovation among the public and the private sectors: contracts, contractual public-private partnership, and institutionalised public-private partnership. We observed that the creation of innovation is directly related to the institutional arrangement chosen to develop each project. Thus, certain innovations are unfeasible without a high degree of maturity in the interorganizational collaboration. However, it is also noteworthy that as the intensity of the collaboration increases, so do costs, and control over the process decreases (AU)

The creation of innovation through public-private collaboration.

This article develops the notion of how different options of public-private collaborations implemented by organizations affect the creation of innovation through a case study: the Blood and Tissue Bank. Data were obtained through in-depth semi-structured interviews with the entire managerial team of the organization under analysis. We coded the interviews, and implemented content analysis. These data were triangulated with the analysis of the organization's internal documents. This article contributes to the understanding of innovation management in public-private collaborations in health professions by identifying the existence of different options in an organization to develop collaborative innovation among the public and the private sectors: contracts, contractual public-private partnership, and institutionalised public-private partnership. We observed that the creation of innovation is directly related to the institutional arrangement chosen to develop each project. Thus, certain innovations are unfeasible without a high degree of maturity in the interorganizational collaboration. However, it is also noteworthy that as the intensity of the collaboration increases, so do costs, and control over the process decreases.

Wound healing and catheter thrombosis after implantable venous access device placement in 266 breast cancers treated with bevacizumab therapy.

The aim of this study was to determine, in a population with metastatic breast cancer treated with bevacizumab therapy, the incidence of wound dehiscence after placement of an implantable venous access device (VAD) and to study the risk of catheter thrombosis. This study enrolled all VADs placed by 14 anesthetists between 1 January 2007 and 31 December 2009: 273 VADs in patients treated with bevacizumab therapy and 4196 VADs in patients not treated with bevacizumab therapy. In the bevacizumab therapy group, 13 cases of wound dehiscence occurred in 12 patients requiring removal of the VAD (4.76%). All cases of dehiscence occurred when bevacizumab therapy was initiated less than 7 days after VAD placement. Bevacizumab therapy was initiated less than 7 days after VAD placement in 150 cases (13 of 150: 8.6%). The risk of dehiscence was the same from 0 to 7 days. In parallel, the VAD wound dehiscence rate in patients not receiving bevacizumab therapy was eight of 4197 cases (0.19%) (Fisher's test significant, P<0.001). No risk factors of dehiscence were identified: anesthetists, learning curves, and irradiated patients. VAD thrombosis occurred in four patients (1.5%). In parallel, VAD thrombosis occurred in 51 of 4197 patients (1.2%) not receiving bevacizumab therapy (Fisher's test not significant; P=0.43). Bevacizumab therapy was permanently discontinued in five patients related to wound dehiscence and in one patient due to extensive skin necrosis. These data suggest the need to observe an interval of at least 7 days between VAD placement and initiation of bevacizumab therapy to avoid the risk of a wound dehiscence requiring chest wall port explant. The risk of VAD thrombosis does not require any particular primary prevention.

Use of a subcutaneous implantable pleural port in the management of recurrent malignant pleurisy: five-year experience based on 168 subcutaneous implantable pleural ports.

INTRODUCTION: The authors report their experience in the use of subcutaneous implantable pleural port (SIPP) catheters for the treatment of symptomatic recurrent malignant pleurisy. MATERIALS AND METHODS: Single-center, prospective follow-up of 137 patients (168 SIPPs). RESULTS: No SIPP placement failures were observed. All but 3 of the 125 evaluable patients obtained complete or partial relief of their dyspnea. Seventy-six patients (60.3%) were receiving chemotherapy. Spontaneous pleurodesis was observed within 2 months in 46 patients (36.8%). Twenty-six patients (20.8%) died during the month following SIPP placement. Forty-one patients (32%) survived for more than 6 months. The overall median survival time was 344 days. Three infectious complications (1 empyema, 2 cellulitis) and 3 mechanical complications were observed. The role of pleurodesis as prognostic factor was assessed. Seventy-one patients survived for more than 2 months, 36 with pleurodesis, 35 without pleurodesis, requiring repeated pleural aspiration. The difference observed between the two groups by the 120th day was no longer significant when chemotherapy was taken into account. CONCLUSION: SIPP is a safe and effective option for the outpatient management of recurrent malignant effusions and could be considered as first-line treatment in all patients with bilateral, compressive pleural effusion or poor lung reexpansion.

Management of operable invasive breast cancer in women over the age of 70: long-term results of a large-scale single-institution experience.

BACKGROUND: The treatment of choice for elderly women with breast cancer remains controversial. This retrospective analysis of a cohort from a single institution was designed to evaluate whether such patients are really undertreated because of their age and to reappraise their usual management. METHODS: The characteristics of 538 patients aged > or = 70 years with operable breast cancer, treated between 1995 and 1999, were retrospectively analyzed comparing patients aged 70 to 75 years (group I, n = 288), 75 to 80 years (group II, n = 156), and > or = 80 years (group III, n = 94). Cause-specific survival, distant recurrence-free interval, and local control were estimated by the Kaplan-Meier method and compared by log rank test. Multivariate analysis used Cox regression. RESULTS: In group III, tumors were more frequently T2 than T1 (P < 0.0001) and estrogen receptor negative (P = 0.045) than in groups I and II. Surgery was performed in 94.6% of patients, breast-conserving in 72.1% (62% in group III; P = 0.0015) with axillary dissection in 89.2% (77% in group III; P = 0.0015); 100% received radiotherapy after lumpectomy (hypofractionated in 63% of group III; P < 0.0001). Adjuvant hormone therapy and chemotherapy were administered to 57 and 3.7% of patients, respectively. At 7 years, no difference in the three groups was observed for cause-specific survival (91% for group I, 89% for group II, 86% for group III) distant recurrence-free interval, and local control (>90%). CONCLUSIONS: Elderly patients with operable breast cancer who are completely and correctly treated with realistic treatment options that are based on surgery and adjuvant radiotherapy have a similar chance of being cured as younger patients.

Effects of dietary L-arginine intake on cardiorespiratory and metabolic adaptation in athletes.

To assess the effect of diet enrichment with L-arginine or supplementation at high doses on physiological adaptation during exercise, 9 athletes followed 3 different diets, each over 3 consecutive days, with a wash-out period of 4 d between training sessions: control diet (CD), 5.5 +/- 0.3 g/d of L-arginine; Diet 1 (rich in L-arginine food), 9.0 +/- 1.1 g/d of L-arginine; and Diet 2 (the same as CD but including an oral supplement of 15 g/d), 20.5 +/- 0.3 g/d of L-arginine. Plasma nitrate levels of each participant were determined on the day after each treatment. Participants performed a submaximal treadmill test (initial speed 10-11 km/hr, work increments 1 km/hr every 4 min until 85-90% VO2max, and passive recovery periods of 2 min). Oxygen uptake and heart rate were monitored throughout the test. Blood lactate concentration ([La-]b) was determined at the end of each stage. Repeated-measures ANOVA and paired Student's t tests were used to compare the various physiological parameters between diets. The level of significance was set at p < .05. [La-]b showed a significant effect at the 5-min time point between CD and Diet 2 (CD 3.0 +/- 0.5 mM, Diet 2 2.5 +/- 0.5 mM, p = .03), but this tendency was not found at higher exercise intensities. No significant differences were observed in any of the cardiorespiratory or plasma nitrate levels. In conclusion, dietary L-arginine intake on the days preceding the test does not improve physiological parameters during exercise.

Prenatal programming of sporting success: associations of digit ratio (2D:4D), a putative marker for prenatal androgen action, with world rankings in female fencers.

Associations of the second-to-fourth digit ratio (2D:4D), a putative marker for prenatal androgen action, and of absolute finger length, a putative marker for pubertal-adolescent androgen action, with sport performance were examined in a multinational sample of 87 world-class women epee fencers. Lower (masculinized) digit ratios correlated, although not significantly so, with better current and highest past world rankings. These correlations were significant for right-hand 2D:4D with controls for the most salient factors for 2D:4D (ethnicity) and world rankings (years of international experience, height, and weight). Longer (masculinized) fingers correlated strongly with better current and highest past world rankings; these correlations became insignificant with the same controls. Replicating previous evidence for fencers, left-handedness was much more prevalent in this sample (21%) than in the female general population, and left-handers had somewhat, but not significantly so, lower 2D:4D as well as better world rankings than right-handers. These findings extend related evidence suggestive of prenatal programming of aptitude across a variety of sports, especially running and soccer. Some known extragenital effects of prenatal testosterone that contribute to the development of efficient cardiovascular systems, good visuospatial abilities, physical endurance and speed, and to the propensity for rough-and-tumble play, apparently promote sporting success in adult life.

Conservative treatments of intraocular retinoblastoma.

OBJECTIVE: To describe the efficacy of conservative management of retinoblastoma by an association of conservative ocular therapies and chemothermotherapy. DESIGN: Phase II prospective nonrandomized trial. PARTICIPANTS: Eighty-three children were included (115 eyes). METHODS: Conservative ocular therapies and chemothermotherapy (intravenous carboplatin followed by transpupillary thermotherapy to the tumor) after chemoreduction by 2 cycles of carboplatin and etoposide. MAIN OUTCOME MEASURES: Use of external beam therapy and ocular tumor control. RESULTS: One hundred fifteen of the 147 affected eyes were eligible for conservative management. Nineteen children had unilateral lesions (22.8%), and 64 (77.1%) had bilateral lesions. Sixty-six children received neoadjuvant chemotherapy before ocular therapy, which consisted of one or a combination of several techniques: chemothermotherapy (65 children [86 eyes]) with a mean of 3 cycles per child, thermotherapy alone (22 children [24 eyes]), cryoapplication (49 children [58 eyes]), and iodine 125 brachytherapy (26 children [29 eyes]). Tumor control was achieved for 97 eyes (84%). At the end of the study, external beam radiotherapy (EBR) was necessary for a total of 9 children (11%) and 13 eyes (12%). Enucleation was necessary for a total of 23 eyes (20%), because of complications in 5 cases. CONCLUSIONS: Neoadjuvant chemotherapy with 2 cycles of carboplatin and etoposide followed by ocular therapy and chemothermotherapy achieves satisfactory tumor control and permits a low need for EBR.

Use of a pleural implantable access system for the management of malignant pleural effusion: the Institut Curie experience.

PURPOSE: Malignant pleural effusion has a very poor prognosis, raises problems of medical management, and impairs quality of life. The authors report the first experience of a pleural implantable access system for the treatment of recurrent symptomatic malignant pleural effusion. DESCRIPTION: Prospective follow-up of 29 patients between August 20, 2005 and August 1, 2007 in a single center. Thirty-four pleural implantable access systems were placed in 29 patients (23 patients with breast cancers, 4 patients with bilateral placements, and 1 patient with a replacement) under sedation after the decision of a multidisciplinary meeting. EVALUATION: Twenty-eight patients obtained partial or complete relief of their dyspnea. Six patients underwent pleurodesis after a maximum of 2 months. Fifteen patients were receiving chemotherapy at the time of placement. Seven patients died at the Institut Curie or in a palliative care unit without returning home. The other 22 patients presented a total of 280 days of hospitalization for 2,717 days of catheter implantation. No placement failures were observed in this series. Two infectious complications (infectious pneumonia and skin infection over the puncture site) and two mechanical complications (expulsion of the port and disconnection between the port and the catheter) were observed and easily treated. One patient had loculation of the pleural cavity develop after 16 thoracenteses making further thoracentesis ineffective. CONCLUSIONS: The pleural implantable access system is an interesting alternative in terms of efficacy and safety for the outpatient management of malignant pleural effusion. It presents a number of advantages in terms of comfort and infectious risk compared with tunnelled pleural catheters.

[Specific aspects of the pre-anaesthetic consultation in patients with cancer]. / Aspects spécifiques de la consultation préanesthésique chez le patient cancéreux.

This article focuses on the problems which the anaesthetist faces in the preoperative evaluation of patients with cancer and the specific aspects of this consultation. The multidisciplinary approach to the care of patients with cancer demands an understanding of all aspects of its treatment. Chemotherapy, radiotherapy and surgery are often combined and are very successful. Both the anatomic and physiologic alterations resulting from the presence of a malignancy as well as the consequences of previous and concurrent therapy may have profound effects on the perioperative management of the patient. The awareness and treatment of specific cancer related problems, allows optimal anesthetic care and the management of acute and chronic pain and terminal illness.