Anastomotic Suturing Techniques and Their Association With Post-Lung Transplantation Complications.

INTRODUCTION: Currently, standard practice is to use the continuous suturing technique on the bronchial anastomosis during lung transplantation. This study used a large cohort to investigate and contrast continuous and interrupted suturing techniques, comparing survival outcomes and occurrence of postoperative bronchial complications to examine if utilization of interrupted suturing has merit. METHODS: Survival outcomes of 740 single-center lung transplant recipients over 8 y (February 2012-March 2020) were compared by suturing techniques: either continuous or interrupted at the bronchial anastomosis. Clinical parameters and demographics were compared between two suturing groups, with P values < 0.05 considered significant. The groups were compared for postoperative morbidity, including need for bronchial interventions. Survival was compared using Kaplan-Meier curves and log-rank tests. Cox regression analysis was run with statistically significant variables to study association with survival. RESULTS: Of the 740 patients, 462 received the continuous suturing technique and 278 received the interrupted suturing technique. Most demographic and clinical data were not statistically significant between the two groups, and those that were significant were not associated with worse survival outcomes, with the exception of the variable diagnosis. Bronchial complications were comparable between the continuous and interrupted groups (12.6% versus 10.4%, P = 0.382). Extracorporeal membrane oxygenation (ECMO) use did not differ significantly between the two groups (P = 0.12). The Kaplan-Meier curve showed comparable survival between groups (P = 0.98), and Cox regression analysis showed that only diagnosis, bronchial complications, and ECMO utilization were associated with different survival outcomes. Chronic obstructive pulmonary disorder was shown to be associated with more favorable survival outcomes as opposed to idiopathic pulmonary fibrosis and the category "other". The need for ECMO and the occurrence of a bronchial complication were also associated with worse survival outcomes. CONCLUSIONS: Both techniques showed reasonable post-transplant outcomes, as our study demonstrated similar survival outcomes and bronchial complication rates.

Examining College Music Majors' Perceived Barriers and Motivation to Exercise.

Previous research has revealed music majors, in general, do not identify as exercisers, subjecting them to various health risks. Influenced by self-determination theory, the current study examined exercise motivation and self-efficacy in overcoming barriers to exercise in relation to number of times per week collegiate music majors reported they engaged in physical exercise. One hundred six college music majors completed a demographic questionnaire regarding their participation in marching music activities and how many days per week they engaged in physical exercise. They also completed two standardized questionnaires that assessed their motivation to exercise (i.e., Behavioural Regulation in Exercise Questionnaire-2) and their confidence in overcoming barriers to exercise (i.e., Barriers Specific Self-Efficacy Scale). Results indicated that music majors who espoused a stronger identified motivation to exercise and had greater self-efficacy in their perceived ability to overcome barriers to exercise reported a greater frequency of exercise engagement. Sex difference were also found, with female music students being less confident (than their male counterparts) in their ability to overcome barriers to exercise. These findings highlight the motivations, obstacles, and perceptions of exercise in the music culture, providing a helpful start for comprehending what drives individuals in this domain.

Use of puppets to teach resourcefulness skills to women who self-injure: An exploratory study.

BACKGROUND: Self-injurious behavior (SIB), when frequent and repetitive, can lead to risk behaviors resulting in accidental or intentional suicide. Psychoeducation about resourcefulness can be critical to interrupt the cycle of self-injury. Therapeutic puppetry provides a safe and secure vehicle for expressing feelings without fear of retaliation. OBJECTIVES: Determine the outcome of a resourcefulness psychoeducation program, utilizing hand puppets as a teaching tool, on the measure of resourcefulness for adult women who self-injure. METHODS: A psychoeducation program, utilizing hand puppets as a teaching tool, was offered to women during psychiatric hospitalization. Participants completed the Resourcefulness Scale (RS) pre and post intervention. A program evaluation to determine the effectiveness of hand puppets was completed. Acceptability and feasibility of the program was evaluated. RESULTS: Sixteen participants completed the program. Results showed a statistically insignificant increase in scores. The program evaluation revealed agreement that resourcefulness learning was accomplished. Participants reported that hand puppets were helpful in practicing resourcefulness skills. Majority of participants recommended continuation of the program.

Microresonator-based comb generation without an external laser source.

We demonstrate a fiber-microresonator dual-cavity architecture with which we generate 880 nm of comb bandwidth without the need for a continuous-wave pump laser. Comb generation with this pumping scheme is greatly simplified as compared to pumping with a single frequency laser, and the generated combs are inherently robust due to the intrinsic feedback mechanism. Temporal and radio frequency (RF) characterization show a regime of steady comb formation that operates with reduced RF amplitude noise. The dual-cavity design is capable of being integrated on-chip and offers the potential of a turn-key broadband multiple wavelength source.

Strong polarization mode coupling in microresonators.

We observe strong modal coupling between the TE00 and TM00 modes in Si3N4 ring resonators revealed by avoided crossings of the corresponding resonances. Such couplings result in significant shifts of the resonance frequencies over a wide range around the crossing points. This leads to an effective dispersion that is one order of magnitude larger than the intrinsic dispersion and creates broad windows of anomalous dispersion. We also observe the changes to frequency comb spectra generated in Si3N4 microresonators due to polarization mode and higher-order mode crossings and suggest approaches to avoid these effects. Alternatively, such polarization mode crossings can be used as a tool for dispersion engineering in microresonators.

A dominant negative heterozygous G87R mutation in the zinc transporter, ZnT-2 (SLC30A2), results in transient neonatal zinc deficiency.

Zinc is an essential mineral, and infants are particularly vulnerable to zinc deficiency as they require large amounts of zinc for their normal growth and development. We have recently described the first loss-of-function mutation (H54R) in the zinc transporter ZnT-2 (SLC30A2) in mothers with infants harboring transient neonatal zinc deficiency (TNZD). Here we identified and characterized a novel heterozygous G87R ZnT-2 mutation in two unrelated Ashkenazi Jewish mothers with infants displaying TNZD. Transient transfection of G87R ZnT-2 resulted in endoplasmic reticulum-Golgi retention, whereas the WT transporter properly localized to intracellular secretory vesicles in HC11 and MCF-7 cells. Consequently, G87R ZnT-2 showed decreased stability compared with WT ZnT-2 as revealed by Western blot analysis. Three-dimensional homology modeling based on the crystal structure of YiiP, a close zinc transporter homologue from Escherichia coli, revealed that the basic arginine residue of the mutant G87R points toward the membrane lipid core, suggesting misfolding and possible loss-of-function. Indeed, functional assays including vesicular zinc accumulation, zinc secretion, and cytoplasmic zinc pool assessment revealed markedly impaired zinc transport in G87R ZnT-2 transfectants. Moreover, co-transfection experiments with both mutant and WT transporters revealed a dominant negative effect of G87R ZnT-2 over the WT ZnT-2; this was associated with mislocalization, decreased stability, and loss of zinc transport activity of the WT ZnT-2 due to homodimerization observed upon immunoprecipitation experiments. These findings establish that inactivating ZnT-2 mutations are an underlying basis of TNZD and provide the first evidence for the dominant inheritance of heterozygous ZnT-2 mutations via negative dominance due to homodimer formation.

Modelocking and femtosecond pulse generation in chip-based frequency combs.

We investigate simultaneously the temporal and optical and radio-frequency spectral properties of parametric frequency combs generated in silicon-nitride microresonators and observe that the system undergoes a transition to a mode-locked state. We demonstrate the generation of sub-200-fs pulses at a repetition rate of 99 GHz. Our calculations show that pulse generation in this system is consistent with soliton modelocking. Ultimately, such parametric devices offer the potential of producing ultra-short laser pulses from the visible to mid-infrared regime at repetition rates from GHz to THz.

BMI changes among marching artists: a longitudinal study.

In a series of longitudinal analyses, we examined body mass index (BMI) of drum and bugle corps performers at the beginning (Time 1) and end (Time 2) of a competitive season and again at a 1-year follow-up (Time 3). Utilizing an archival database, BMI data were recorded for 501 marching arts performers, representing four world-class drum and bugle corps. Significant reductions in BMI were found between Time 1 and Time 2 for performers in all sections (i.e., brass, percussion, and color guard). Archival data from 92 performers, representing three world-class drum and bugle units, revealed BMI significantly increased from Time 2 to Time 3. In an effort to identify possible personal influences on the changes in BMI found between Times 2 and 3, 50 performers from one drum and bugle corps provided archival data on a measures of performers' athletic identity (i.e., the strength and exclusivity of one's identification with the athlete role) along with BMI. Correlational analyses revealed that performers' athletic identity negatively related to BMI change from Time 1 and Time 3 and Times 2 and 3 (i.e., stronger athletic identity, lower BMI change). Practical implications are discussed.

Brazilian Jiu Jitsu players' motivations to train.

Combat sports, such as Brazilian Jiu Jitsu (BJJ), require intense physical, mental, and emotional tasking within its training. With the degree of difficulty ingrained within the sport, many participants that once were intrigued by the sport may lose this interest and enjoyment if their goals are not met. The purpose of this study was to examine the relative strength of sport motivations among BJJ players. Participants included 228 BJJ athletes varying in levels of sport participation experience. Grounded in Self-Determination Theory, participants were assessed on five motives for sport participation including: fitness, appearance, competence, social, and interest/enjoyment. Motives related to interest/enjoyment, competence, and fitness, were rated relatively higher; and appearance and social were rated relatively lower regarding participants' motivation for BJJ participation. Analyses were also conducted related to athletes' years of experience and competitive level of participation (i.e., hobbyist or non-competitor to those who compete on a regular basis) There was a significant effect of competence and interest/enjoyment motivators among competitive BJJ players, regardless of years of experience in the sport. Findings from this study could aid coaches, sport clinicians, and sport psychologists in working with BJJ players by focusing their training on the motivators that are most appealing to these athletes.

Broadband parametric frequency comb generation with a 1-µm pump source.

We report the first experimental demonstration of broadband frequency comb generation from a single-frequency pump laser at 1-µm using parametric oscillation in a high-Q silicon-nitride ring resonator. The resonator dispersion is engineered to have a broad anomalous group velocity dispersion region near the pump wavelength for efficient parametric four-wave mixing. The comb spans 55 THz with a 230-GHz free spectral range. These results demonstrate the powerful advantage of dispersion engineering in chip-based devices for producing combs with a wide range of pump wavelengths.

Asynchronous single-shot characterization of high-repetition-rate ultrafast waveforms using a time-lens-based temporal magnifier.

We demonstrate asynchronous, single-shot characterization of an ultrafast, high-repetition-rate pulse source using a time-lens-based temporal magnifier. We measure a 225 GHz repetition-rate pulse train from a microresonator-based frequency comb. In addition, we show that such a system can be used as a frequency compressor for real-time, high-speed RF spectral characterization.

UWB monocycle pulse generation using two-photon absorption in a silicon waveguide.

We propose and experimentally demonstrate ultrawideband monocycle pulse generation using nondegenerate two-photon absorption in a silicon waveguide. The free-carrier absorption induced pulse tail at the rising edge of inverted probe pulse is largely compensated by the overlapped pump pulse and results in a symmetric negative monocycle pulse. A 143 ps Gaussian monocycle pulse is successfully obtained with a 131.7% fractional 10 dB bandwidth using a 68 ps pulsed pump. The 10 dB bandwidth and center frequency of the RF spectrum for the generated monocycle pulse can be largely tuned using an optical delay line. An operational bandwidth of 30 nm is demonstrated experimentally with stable performance, and larger optical bandwidth is expected.

Chip-based frequency combs with sub-100 GHz repetition rates.

By fabricating high-Q silicon-nitride spiral resonators, we demonstrate frequency combs spanning over 200 nm with free spectral ranges (FSRs) of 80, 40, and 20 GHz using cascaded four-wave mixing. We characterize the RF beat note for the 20 GHz FSR comb, and the measured linewidth of 3.6 MHz is consistent with thermal fluctuations in the resonator due to amplitude noise of the pump source. These combs represent an important advance towards developing a complementary metal-oxide-semiconductor (CMOS)-based system capable of linking the optical and electronic regimes.

Postoperative Bronchial Complications After Lung Transplantation Related to Anastomosis Suture.

BACKGROUND: Postoperative bronchial anastomotic complications are not uncommon in lung transplant recipients. We investigated 2 surgical techniques (continuous and interrupted sutures) during bronchial anastomosis, comparing survival and postoperative bronchial complications. METHODS: We retrospectively analyzed 421 patients who were transplanted in our center (February 2012 to March 2018). Patients were divided according to bronchial anastomotic technique (continuous or interrupted). Demographics and clinical parameters were compared for significance (P < .05). Comparison of postoperative morbidity included bronchial complications, venovenous extracorporeal membrane oxygenation support, and intervention requirements. Survival was assessed using Kaplan-Meier curve and log-rank tests (P < .05). RESULTS: Of the 421 patients, 290 underwent bronchial anastomoses with continuous suture; 44 of these patients had postoperative bronchial complications (15.2%). Contrarily, 131 patients underwent the interrupted suture technique; 9 patients in this group had postoperative bronchial complications (6.9%). Demographics and clinical parameters included age, sex, ethnicity, etiology, lung allocation score, body mass index, donor age, lung transplant type, cardiopulmonary bypass usage, surgical approaches, and median length of stay. Postoperative complications (continuous vs interrupted) were bronchial complications (P = .017), venovenous extracorporeal membrane oxygenation support (P = .41), venoarterial extracorporeal membrane oxygenation support (P = .38), and complications requiring dilatation with stent placement (P = .09). Kaplan-Meier curve showed better survival in the interrupted group (P = .0002). CONCLUSIONS: Our study demonstrated the comparable postoperative results between the continuous and interrupted technique.

Harmonic generation in silicon nitride ring resonators.

We demonstrate second- and third-harmonic generation in a centrosymmetric CMOS-compatible material using ring resonators and integrated optical waveguides. The χ(2) response is induced by using the nanoscale structure of the waveguide to break the bulk symmetry of silicon nitride (Si3N4) with the silicon dioxide (SiO2) cladding. Using a high-Q ring resonator cavity to enhance the efficiency of the process, we detect the second-harmonic output in the visible wavelength range with milliwatt input powers at telecom wavelengths. We also observe third-harmonic generation from the intrinsic χ(3) susceptibility of the silicon nitride. Phase matching of the harmonic processes occurs due to the near coincidence of indices of refraction of the fundamental mode at the pump frequency and the corresponding higher-order modes of the harmonic fields.

Silicon-based monolithic optical frequency comb source.

We demonstrate the generation of broad-bandwidth optical frequency combs from a CMOS-compatible integrated microresonator. We characterize the comb quality using a novel self-referencing method and verify that the comb line frequencies are equidistant over a bandwidth of 115 nm (14.5 THz), which is nearly an order of magnitude larger than previous measurements.

Octave-spanning frequency comb generation in a silicon nitride chip.

We demonstrate a frequency comb spanning an octave via the parametric process of cascaded four-wave mixing in a monolithic, high-Q silicon nitride microring resonator. The comb is generated from a single-frequency pump laser at 1562 nm and spans 128 THz with a spacing of 226 GHz, which can be tuned slightly with the pump power. In addition, we investigate the RF amplitude noise characteristics of the parametric comb and find that the comb can operate in a low-noise state with a 30 dB reduction in noise as the pump frequency is tuned into the cavity resonance.

An investigation of musical performance anxiety in the marching arts.

The purpose of this study was to investigate the prevalence of musical performance anxiety (MPA) in marching artists. The marching arts include high school and college marching bands, drum and bugle corps, and indoor color guard and percussion ensembles. Drawing on a sample of 780 world class drum and bugle corps performers, we examined the prevalence of somatic and cognitive symptoms of MPA. We also examined differences in endorsement of symptoms by performing section (i.e., brass players, percussionists, and dancers/color guard) and gender. Results revealed a relatively low prevalence of MPA symptoms as compared with prior studies of adolescent and young adult performers. In addition, color guard performers reported significantly greater magnitudes of somatic MPA symptoms than brass players, and female performers reported greater magnitudes of cognitive MPA symptoms than their male counterparts. Practical recommendations are discussed.

Low penetrance, broad resistance, and favorable outcome of interleukin 12 receptor beta1 deficiency: medical and immunological implications.

The clinical phenotype of interleukin 12 receptor beta1 chain (IL-12Rbeta1) deficiency and the function of human IL-12 in host defense remain largely unknown, due to the small number of patients reported. We now report 41 patients with complete IL-12Rbeta1 deficiency from 17 countries. The only opportunistic infections observed, in 34 patients, were of childhood onset and caused by weakly virulent Salmonella or Mycobacteria (Bacille Calmette-Guérin -BCG- and environmental Mycobacteria). Three patients had clinical tuberculosis, one of whom also had salmonellosis. Unlike salmonellosis, mycobacterial infections did not recur. BCG inoculation and BCG disease were both effective against subsequent environmental mycobacteriosis, but not against salmonellosis. Excluding the probands, seven of the 12 affected siblings have remained free of case-definition opportunistic infection. Finally, only five deaths occurred in childhood, and the remaining 36 patients are alive and well. Thus, a diagnosis of IL-12Rbeta1 deficiency should be considered in children with opportunistic mycobacteriosis or salmonellosis; healthy siblings of probands and selected cases of tuberculosis should also be investigated. The overall prognosis is good due to broad resistance to infection and the low penetrance and favorable outcome of infections. Unexpectedly, human IL-12 is redundant in protective immunity against most microorganisms other than Mycobacteria and Salmonella. Moreover, IL-12 is redundant for primary immunity to Mycobacteria and Salmonella in many individuals and for secondary immunity to Mycobacteria but not to Salmonella in most.

A role for interleukin-12/23 in the maturation of human natural killer and CD56+ T cells in vivo.

Natural killer (NK) cells have been originally defined by their "naturally occurring" effector function. However, only a fraction of human NK cells is reactive toward a panel of prototypical tumor cell targets in vitro, both for the production of interferon-gamma (IFN-gamma) and for their cytotoxic response. In patients with IL12RB1 mutations that lead to a complete IL-12Rbeta1 deficiency, the size of this naturally reactive NK cell subset is diminished, in particular for the IFN-gamma production. Similar data were obtained from a patient with a complete deficit in IL-12p40. In addition, the size of the subset of effector memory T cells expressing CD56 was severely decreased in IL-12Rbeta1- and IL-12p40-deficient patients. Human NK cells thus require in vivo priming with IL-12/23 to acquire their full spectrum of functional reactivity, while T cells are dependent upon IL-12/23 signals for the differentiation and/or the maintenance of CD56(+) effector memory T cells. The susceptibility of IL-12/23 axis-deficient patients to Mycobacterium and Salmonella infections in combination with the absence of mycobacteriosis or salmonellosis in the rare cases of human NK cell deficiencies point to a role for CD56(+) T cells in the control of these infections in humans.