Objective
Prescription opioid use and deaths related to serious toxicity, including overdose, have increased dramatically in the United States since 1999. However, factors associated with serious ...opioid‐related respiratory or central nervous system (CNS) depression or overdose in medical users are not well characterized. The objective of this study was to examine the factors associated with serious toxicity in medical users of prescription opioids.
Design
Retrospective, nested, case‐control analysis of Veterans Health Administration (VHA) medical, pharmacy, and health care resource utilization administrative data.
Subjects
Patients dispensed an opioid by VHA between October 1, 2010 and September 30, 2012 (N = 8,987).
Methods
Cases (N = 817) experienced life‐threatening opioid‐related respiratory/CNS depression or overdose. Ten controls were randomly assigned to each case (N = 8,170). Logistic regression was used to examine associations with the outcome.
Results
The strongest associations were maximum prescribed daily morphine equivalent dose (MED) ≥ 100 mg (odds ratio OR = 4.1, 95% confidence interval CI, 2.6–6.5), history of opioid dependence (OR = 3.9, 95% CI, 2.6–5.8), and hospitalization during the 6 months before the serious toxicity or overdose event (OR = 2.9, 95% CI, 2.3–3.6). Liver disease, extended‐release or long‐acting opioids, and daily MED of 20 mg or more were also significantly associated.
Conclusions
Substantial risk for serious opioid‐related toxicity and overdose exists at even relatively low maximum prescribed daily MED, especially in patients already vulnerable due to underlying demographic factors, comorbid conditions, and concomitant use of CNS depressant medications or substances. Screening patients for risk, providing education, and coprescribing naloxone for those at elevated risk may be effective at reducing serious opioid‐related respiratory/CNS depression and overdose in medical users of prescription opioids.
How the interacting electronic states and phases of layered transition-metal dichalcogenides evolve when thinned to the single-layer limit is a key open question in the study of two-dimensional ...materials. Here, we use angle-resolved photoemission to investigate the electronic structure of monolayer VSe2 grown on bilayer graphene/SiC. While the global electronic structure is similar to that of bulk VSe2, we show that, for the monolayer, pronounced energy gaps develop over the entire Fermi surface with decreasing temperature below T c = 140 ± 5 K, concomitant with the emergence of charge-order superstructures evident in low-energy electron diffraction. These observations point to a charge-density wave instability in the monolayer that is strongly enhanced over that of the bulk. Moreover, our measurements of both the electronic structure and of X-ray magnetic circular dichroism reveal no signatures of a ferromagnetic ordering, in contrast to the results of a recent experimental study as well as expectations from density functional theory. Our study thus points to a delicate balance that can be realized between competing interacting states and phases in monolayer transition-metal dichalcogenides.
Purpose
Polyester multifilament is used to produce the face and back layer of warp knitted spacer fabric (WKSF) and these two layers are connected by polyester monofilament as a middle layer. This ...fabric has unique and extraordinary characteristics, and different possibilities of fabric structure and the middle layer thickness are tried to find out the moisture management properties. The paper aims to discuss these issues.
Design/methodology/approach
This study investigates the influence of fabric thickness and structure on moisture management properties.
Findings
Polyester monofilament quickly up takes the water molecule from the water reservoir and transfers it by capillary action. The gravitational force and the availability space between the two outer surface layers restrict the movement of water molecules, although the pressure develops to push the molecules from the water reservoir. As a result, all the spacer fabric samples attain the equilibrium state very quickly. WKSF and the hexagonal net structure prove to be better in vertical wicking.
Originality/value
The liquid movement is quick in the front side of the spacer fabric, and the rate of wicking is higher in open structure than in the closed structure. It confirms that the hexagonal net structure produces high pore size on fabric and it reaches maximum wicking values. Fabric thickness does not have much influence on the vertical wicking properties of all fabric samples, and the rate of liquid movement produces a similar trend. In in-plane wicking, the polyester monofilament in the middle layer of spacer fabric plays a major role rather than the outer surface layers of fabric.
This overview of the fifth edition of the WHO classification of thymic epithelial tumors (including thymomas, thymic carcinomas, and thymic neuroendocrine tumors NETs), mediastinal germ cell tumors, ...and mesenchymal neoplasms aims to (1) list established and new tumor entities and subtypes and (2) focus on diagnostic, molecular, and conceptual advances since publication of the fourth edition in 2015. Diagnostic advances are best exemplified by the immunohistochemical characterization of adenocarcinomas and the recognition of genetic translocations in metaplastic thymomas, rare B2 and B3 thymomas, and hyalinizing clear cell carcinomas. Advancements at the molecular and tumor biological levels of utmost oncological relevance are the findings that thymomas and most thymic carcinomas lack currently targetable mutations, have an extraordinarily low tumor mutational burden, but typically have a programmed death-ligand 1high phenotype. Finally, data underpinning a conceptual advance are illustrated for the future classification of thymic NETs that may fit into the classification scheme of extrathoracic NETs. Endowed with updated clinical information and state-of-the-art positron emission tomography and computed tomography images, the fifth edition of the WHO classification of thymic epithelial tumors, germ cell tumors, and mesenchymal neoplasms with its wealth of new diagnostic and molecular insights will be a valuable source for pathologists, radiologists, surgeons, and oncologists alike. Therapeutic perspectives and research challenges will be addressed as well.
In the framework of quantum chromodynamics (QCD), parton distribution functions (PDFs) quantify how the momentum and spin of a hadron are divided among its quark and gluon constituents. Two main ...approaches exist to determine PDFs. The first approach, based on QCD factorization theorems, realizes a QCD analysis of a suitable set of hard-scattering measurements, often using a variety of hadronic observables. The second approach, based on first-principle operator definitions of PDFs, uses lattice QCD to compute directly some PDF-related quantities, such as their moments. Motivated by recent progress in both approaches, in this document we present an overview of lattice-QCD and global-analysis techniques used to determine unpolarized and polarized proton PDFs and their moments. We provide benchmark numbers to validate present and future lattice-QCD calculations and we illustrate how they could be used to reduce the PDF uncertainties in current unpolarized and polarized global analyses. This document represents a first step towards establishing a common language between the two communities, to foster dialogue and to further improve our knowledge of PDFs.
The brain is a site of relative immune privilege. Although CD4 T cells have been reported in the central nervous system, their presence in the healthy brain remains controversial, and their function ...remains largely unknown. We used a combination of imaging, single cell, and surgical approaches to identify a CD69+ CD4 T cell population in both the mouse and human brain, distinct from circulating CD4 T cells. The brain-resident population was derived through in situ differentiation from activated circulatory cells and was shaped by self-antigen and the peripheral microbiome. Single-cell sequencing revealed that in the absence of murine CD4 T cells, resident microglia remained suspended between the fetal and adult states. This maturation defect resulted in excess immature neuronal synapses and behavioral abnormalities. These results illuminate a role for CD4 T cells in brain development and a potential interconnected dynamic between the evolution of the immunological and neurological systems.
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•Residential CD4 T cells are present in the healthy mouse and human brain•Brain residency is a transient program initiated in situ and lasting weeks•CD4 T cell entry around birth drives a transcriptional maturation step in microglia•Absence of CD4 T cells results in defective synaptic pruning and behavior
Identification of brain-resident CD4+ T cells in mice and humans, which are required for microglia maturation and proper synaptic pruning and behavior.
•Presence of masks on faces degrade the performance of existing models trained on normal images.•Training with both normal and masked faces boosts masked face recognition performance.•Performance gap ...between deep and shallow models are wider in masked face recognition.•Optimal hyper-parameters for masked face recognition differ from normal face recognition.•CosFace loss function produces the best results on masked faces.•Real-world performance is reliant on the diversity of masks in training set.
Face recognition has a wide range of applications like video surveillance, security, access control, etc. Over the past decade, the field of face recognition has matured and grown at par with the latest advancements in technology, particularly deep learning. Convolution Neural Networks have surpassed human accuracy in Face Recognition on popular evaluation tests such as LFW. However, most existing models evaluate their performance with an assumption of the availability of full facial information. The COVID-19 pandemic has laid forth challenges to this assumption, and to the performance of existing methods and leading-edge algorithms in the field of face recognition. This is in the wake of an explosive increase in the number of people wearing face masks. The reduced amount of facial information available to a recognition system from a masked face impacts their discrimination ability. In this context, we design and conduct a series of experiments comparing the masked face recognition performances of CNN architectures available in literature and exploring possible alterations in loss functions, architectures, and training methods that can enable existing methods to fully extract and leverage the limited facial information available in a masked face. We evaluate existing CNN-based face recognition systems for their performance against datasets composed entirely of masked faces, in contrast to the existing standard evaluations where masked or occluded faces are a rare occurrence. The study also presents evidence denoting an increased impact of network depth on performance compared to standard face recognition. Our observations indicate that substantial performance gains can be achieved by the introduction of masked faces in the training set. The study also inferred that various parameter settings determined suitable for standard face recognition are not ideal for masked face recognition. Through empirical analysis we derived new value recommendations for these parameters and settings.
Of all microorganisms in the human body, the largest and most complex population resides in the gastrointestinal (GI) tract. The gut microbiota continuously adapts to the host environment and serves ...multiple critical functions for their hosts, including regulating host immunity, procuring energy from food, and preventing the colonization of pathogens. Mounting evidence has suggested gut microbial imbalance (dysbiosis) as a core pathophysiology in the development of GI motility and metabolic disorders, such as irritable bowel syndrome and diabetes. Current research has focused on discovering associations between these disorders and gut microbial dysbiosis; however, whether these associations are a consequence or cause is still mostly unexplored. State-of-the-art studies have investigated how gut microbes communicate with our body systems through microbiota-derived metabolites and how they are able to modulate host physiology. There is now mounting evidence that alterations in the composition of small intestinal microbes have an association with GI dysmotility and metabolic disorders. Although treatment options for gut microbial dysbiosis are currently limited, antibiotics, fecal microbiota transplantation, probiotics, and dietary interventions are currently the best options. However, treatment with broad-spectrum antibiotics has been viewed with skepticism due to the risk of developing antibiotic resistant bacteria. Studies are warranted to elucidate the cellular and molecular pathways underlying gut microbiota-host crosstalk and for the development of a powerful platform for future therapeutic approaches. Here, we review recent literature on gut microbial alterations and/or interactions involved in the pathophysiology of GI dysmotility and metabolic disorders.
We present a large-scale, volume-limited companion survey of 245 late-K to mid-M (K7-M6) dwarfs within 15 pc. Infrared adaptive optics (AO) data were analysed from the Very Large Telescope, Subaru ...Telescope, Canada–France–Hawaii Telescope, and MMT Observatory to detect close companions to the sample from ∼ 1 to 100 au, while digitized wide-field archival plates were searched for wide companions from ∼ 100 to 10 000 au. With sensitivity to the bottom of the main sequence over a separation range of 3 to 10 000 au, multiple AO and wide-field epochs allow us to confirm candidates with common proper motions, minimize background contamination, and enable a measurement of comprehensive binary statistics. We detected 65 comoving stellar companions and find a companion star fraction of 23.5 ± 3.2 per cent over the 3 au to 10 000 au separation range. The companion separation distribution is observed to rise to a higher frequency at smaller separations, peaking at closer separations than measured for more massive primaries. The mass ratio distribution across the q = 0.2–1.0 range is flat, similar to that of multiple systems with solar-type primaries. The characterization of binary and multiple star frequency for low-mass field stars can provide crucial comparisons with star-forming environments and hold implications for the frequency and evolutionary histories of their associated discs and planets.
Quasiparticle interference (QPI) imaging is well established to study the low-energy electronic structure in strongly correlated electron materials with unrivalled energy resolution. Yet, being a ...surface-sensitive technique, the interpretation of QPI only works well for anisotropic materials, where the dispersion in the direction perpendicular to the surface can be neglected and the quasiparticle interference is dominated by a quasi-2D electronic structure. Here, we explore QPI imaging of galena, a material with an electronic structure that does not exhibit pronounced anisotropy. We find that the quasiparticle interference signal is dominated by scattering vectors which are parallel to the surface plane however originate from bias-dependent cuts of the 3D electronic structure. We develop a formalism for the theoretical description of the QPI signal and demonstrate how this quasiparticle tomography can be used to obtain information about the 3D electronic structure and orbital character of the bands.
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