To evaluate the retinal nerve fiber layer (RNFL) thickness and macular volume in neuromyelitis optica (NMO) spectrum patients using optical coherence tomography (OCT).
OCT can quantify damage to ...retinal ganglion cell axons and can identify abnormalities in multiple sclerosis and optic neuritis (ON) eyes. OCT may also be useful in the evaluation of patients with NMO.
OCT and visual function testing were performed in 26 NMO spectrum patients with a history of ON, 17 patients with isolated longitudinally extensive transverse myelitis (LETM) without ON, 378 patients with relapsing-remitting multiple sclerosis (RRMS), and 77 healthy controls at 2 centers.
Substantial RNFL thinning was seen in NMO ON eyes (63.6 microm) relative to both RRMS ON eyes (88.3 microm, p < 0.0001) and control eyes (102.4 microm, p < 0.0001). A first episode of ON was estimated to cause 24 microm more loss of RNFL thickness in NMO than RRMS. Similar results were seen for macular volume. ON also was associated with more severe visual impairment in NMO spectrum patients than in RRMS patients. Eyes in the LETM group and unaffected NMO eyes were not significantly different from controls, though conclusions about these subgroups were limited by small sample sizes.
Optical coherence tomography (OCT) shows more severe retinal damage after optic neuritis (ON) episodes in neuromyelitis optica (NMO) than in relapsing-remitting multiple sclerosis. Identification of substantial retinal nerve fiber layer loss (>15 microm) after ON in a non-multiple sclerosis patient should prompt consideration of an NMO spectrum condition. OCT may be a useful tool for the evaluation of patients with NMO.
We report the results of a search for ν(e) appearance in a ν(μ) beam in the MINOS long-baseline neutrino experiment. With an improved analysis and an increased exposure of 8.2 × 10(20) protons on the ...NuMI target at Fermilab, we find that 2 sin(2) (θ(23))sin(2)(2θ(13))<0.12(0.20) at 90% confidence level for δ = 0 and the normal (inverted) neutrino mass hierarchy, with a best-fit of 2sin(2) (θ(23))sin(2)(2θ(13)) = 0.041(-0.031)(+0.047) (0.079(-0.053) (+0.071)). The θ(13) = 0 hypothesis is disfavored by the MINOS data at the 89% confidence level.
Purpose
A retrieval program was developed in New South Wales (NSW), Australia to provide extracorporeal membrane oxygenation support (ECMO) for the safe transport of adults with severe, acute ...respiratory or cardiac failure. We describe the development and results of this program and the impact of the 2009 H1N1 epidemic on this service.
Methods
An observational study of all patients who were retrieved on ECMO support in NSW, from March 1, 2007 to June 1, 2010, was carried out.
Results
Forty adult patients were retrieved on ECMO support (median age 34 years). The indications for retrieval were respiratory in 38 patients (of whom 16 were confirmed or suspected H1N1 cases) and cardiac in 2 patients. Two other patients died after referral but before ECMO support could be established. Patients were transported by road (
n
= 26, 65%), medical retrieval jet (
n
= 10, 25%) and helicopter (
n
= 4, 10%). The median retrieval distance was 250 km (range 12–1,960 km). Thirty-four patients (85%) survived to hospital discharge. Survival for respiratory indications was 87% (33/38 patients) and 50% (1/2 patients) for cardiac indications. There were no deaths or major morbidity associated with these retrievals.
Conclusions
Patients with very severe respiratory failure, which was considered to preclude conventional ventilation for safe transfer to tertiary centres, were managed by an ECMO referral and retrieval program in NSW and had a high rate of survival. This program also enhanced the capacity of the state to respond to a surge in demand for ECMO support due to the H1N1 epidemic, although the role of ECMO in respiratory failure is not yet well defined.
To estimate longitudinal changes in a quantitative whole-brain and tract-specific MRI study of multiple sclerosis (MS), with the intent of assessing the feasibility of this approach in clinical ...trials.
A total of 78 individuals with MS underwent a median of 3 scans over 2 years. Diffusion tensor imaging indices, magnetization transfer ratio, and T2 relaxation time were analyzed in supratentorial brain, corpus callosum, optic radiations, and corticospinal tracts by atlas-based tractography. Linear mixed-effect models estimated annualized rates of change for each index, and sample size estimates for potential clinical trials were determined.
There were significant changes over time in fractional anisotropy and perpendicular diffusivity in the supratentorial brain and corpus callosum, mean diffusivity in the supratentorial brain, and magnetization transfer ratio in all areas studied. Changes were most rapid in the corpus callosum, where fractional anisotropy decreased 1.7% per year, perpendicular diffusivity increased 1.2% per year, and magnetization transfer ratio decreased 0.9% per year. The T2 relaxation time changed more rapidly than diffusion tensor imaging indices and magnetization transfer ratio but had higher within-participant variability. Magnetization transfer ratio in the corpus callosum and supratentorial brain declined at an accelerated rate in progressive MS relative to relapsing-remitting MS. Power analysis yielded reasonable sample sizes (on the order of 40 participants per arm or fewer) for 1- or 2-year trials.
Longitudinal changes in whole-brain and tract-specific diffusion tensor imaging indices and magnetization transfer ratio can be reliably quantified, suggesting that small clinical trials using these outcome measures are feasible.
► A fully coupled chemoelastic theory is applied in the analysis. ► Effects of concentration-dependent modulus derived from experiments are studied. ► Fick's first law is modified to cover the full ...range of concentrations. ► Significant effect of bending stress gradient on Li-ion diffusion is found.
During the lithiation of a Si anode from pure Si to fully lithiated alloy, the volume expands four times and modulus varies by several tens of times. Thus, the Li-ion diffusion and the stress evolution can be strongly coupled, which may play a significant role in determining the anode performance. In this work, we present a theoretical study of the fully coupled diffusion and stresses in a nonequilibrium LiSi system by taking into account the effects of composition-dependent modulus, finite concentration, and boundary constraint. The Li-ion diffusion and induced stresses in a bilayer Cu-coated Si anode at the nanometer scale is examined to show these important effects. The transient stress-assisted diffusion problem is solved numerically by a finite difference method, whilst the stress field is obtained analytically. It is shown that the modulus variation with composition plays a mild role in the Li-ion diffusion. In order to account for the finite concentration effect, a nonlinear flux equation is introduced that describes the Li-ion diffusion over the full range of concentration from dilute to near-saturation state in a unified, symmetric manner. The finite concentration effect is significant, especially during the early delithiation process. The boundary constraint effect is found to play an intriguing role in the chemical diffusion. The bending stress results in a resisting force to Li-ion flow preventing effectively the Si anode from full lithiation. The constraint effect is significant for a wide range of Cu thickness.
Young's modulus for Li12Si7 was determined from nanoindentation testing. Young's modulus for Li12Si7 was 52.0±8.2GPa. This value is in excellent agreement with estimated values of Young's modulus ...calculated from predicted values of bulk modulus using density functional theory.
► Polycrystalline Li12Si7 was synthesized. ► Nanoindentation testing was used to measure Young's modulus for Li12Si7. Young's modulus was 52.0±8.2GPa. ► The experimental values of Young's moduli for Li12Si7 and Li22Si5 are in excellent agreement with estimated values estimated from predicted values of bulk modulus based on density functional theory.
We report an improved measurement of ν(μ) disappearance over a distance of 735 km using the MINOS detectors and the Fermilab Main Injector neutrino beam in a ν(μ)-enhanced configuration. From a total ...exposure of 2.95×10(20) protons on target, of which 42% have not been previously analyzed, we make the most precise measurement of Δm2=2.62(-0.28)(+0.31)(stat)±0.09(syst)×10(-3) eV2 and constrain the ν(μ) mixing angle sin2(2θ)>0.75 (90% C.L.). These values are in agreement with Δm2 and sin2(2θ) measured for ν(μ), removing the tension reported in P. Adamson et al. (MINOS), Phys. Rev. Lett. 107, 021801 (2011)..
We searched for a sidereal modulation in the MINOS far detector neutrino rate. Such a signal would be a consequence of Lorentz and CPT violation as described by the standard-model extension ...framework. It also would be the first detection of a perturbative effect to conventional neutrino mass oscillations. We found no evidence for this sidereal signature, and the upper limits placed on the magnitudes of the Lorentz and CPT violating coefficients describing the theory are an improvement by factors of 20-510 over the current best limits found by using the MINOS near detector.
There is a well-known relationship between MS and damage to the optic nerve, but advanced, quantitative MR imaging methods have not been applied to large cohorts. Our objective was to determine ...whether a short imaging protocol (< 10 minutes), implemented with standard hardware, could detect abnormal water diffusion in the optic nerves of patients with MS.
We examined water diffusion in human optic nerves via DTI in the largest MS cohort reported to date (104 individuals, including 38 optic nerves previously affected by optic neuritis). We also assessed whether such abnormalities are associated with loss of visual acuity (both high and low contrast) and damage to the retinal nerve fiber layer (assessed via optical coherence tomography).
The most abnormal diffusion was found in the optic nerves of patients with SPMS, especially in optic nerves previously affected by optic neuritis (19% drop in FA). DTI abnormalities correlated with both retinal nerve fiber layer thinning (correlation coefficient, 0.41) and loss of visual acuity, particularly at high contrast and in nerves previously affected by optic neuritis (correlation coefficient, 0.54). However, diffusion abnormalities were overall less pronounced than retinal nerve fiber layer thinning.
DTI is sensitive to optic nerve damage in patients with MS, but a short imaging sequence added to standard clinical protocols may not be the most reliable indicator of optic nerve damage.
Latinx in the USA experience disparities in morbidity and mortality when compared to their non-Hispanic White counterparts. Patient-centered culturally sensitive health care (PC-CSHC) has been deemed ...a best practice approach to alleviate and eliminate these disparities. However, literature on how Latinx patients perceive their care and what indicators of PC-CSHC may be most related to treatment outcomes is limited. This study collected data from 81 adult Latinx participants who had been admitted to an inpatient care unit to understand the following: (a) their perception of their providers’ PC-CSHC in three different areas: Competence/Confidence, Sensitivity/Interpersonal, and Respect/Communication; (b) whether there are differences between English- and Spanish-speaking Latinx patients in their perception of their providers’ PC-CSHC; and (c) whether these PC-CSHC indicators were associated to patient satisfaction, patient-provider communication, and therapeutic alliance. Participants were mostly male, older than 55 years of age, and working or lower class, with English as their primary language. Results showed that patients rated their providers’ Competence (
M
= 3.57,
SD
= .46) higher than both Sensitivity,
t
(68) = .04,
p
= .04, (
M
= 3.49,
SD
=.54), and Respect,
t
(53) = 2.765,
p
= .008, (
M
= 3.38,
SD
= .57). English-speaking Latinx were overall less satisfied with their providers than Spanish-speaking Latinx, in particular in their communication. Finally, higher provider cultural sensitivity appears to be a predictor of patient satisfaction, patient-provider communication, and working alliance. Implications for refining provider trainings to treat this vulnerable and understudied (i.e., Latinx) population are discussed.
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