Exotic Dark Matter Search with the Majorana Demonstrator

With excellent energy resolution and ultralow-level radiogenic backgrounds, the high-purity germanium detectors in the Majorana Demonstrator enable searches for several classes of exotic dark matter (DM) models. In this work, we report new experimental limits on keV-scale sterile neutrino DM via the transition magnetic moment from conversion to active neutrinos ν_{s}→ν_{a}. We report new limits on fermionic dark matter absorption (χ+A→ν+A) and sub-GeV DM-nucleus 3→2 scattering (χ+χ+A→ϕ+A), and new exclusion limits for bosonic dark matter (axionlike particles and dark photons). These searches utilize the (1-100)-keV low-energy region of a 37.5-kg y exposure collected by the Demonstrator between May 2016 and November 2019 using a set of ^{76}Ge-enriched detectors whose surface exposure time was carefully controlled, resulting in extremely low levels of cosmogenic activation.

CTIVA: Censored time interval variable analysis

Traditionally, datasets with multiple censored time-to-events have not been utilized in multivariate analysis because of their high level of complexity. In this paper, we propose the Censored Time Interval Analysis (CTIVA) method to address this issue. It estimates the joint probability distribution of actual event times in the censored dataset by implementing a statistical probability density estimation technique on the dataset. Based on the acquired event time, CTIVA investigates variables correlated with the interval time of events via statistical tests. The proposed method handles both categorical and continuous variables simultaneously-thus, it is suitable for application on real-world censored time-to-event datasets, which include both categorical and continuous variables. CTIVA outperforms traditional censored time-to-event data handling methods by 5% on simulation data. The average area under the curve (AUC) of the proposed method on the simulation dataset exceeds 0.9 under various conditions. Further, CTIVA yields novel results on National Sample Cohort Demo (NSCD) and proteasome inhibitor bortezomib dataset, a real-world censored time-to-event dataset of medical history of beneficiaries provided by the National Health Insurance Sharing Service (NHISS) and National Center for Biotechnology Information (NCBI). We believe that the development of CTIVA is a milestone in the investigation of variables correlated with interval time of events in presence of censoring.

Constraints on the Decay of ^{180m}Ta

^{180m}Ta is a rare nuclear isomer whose decay has never been observed. Its remarkably long lifetime surpasses the half-lives of all other known β and electron capture decays due to the large K-spin differences and small energy differences between the isomeric and lower-energy states. Detecting its decay presents a significant experimental challenge but could shed light on neutrino-induced nucleosynthesis mechanisms, the nature of dark matter, and K-spin violation. For this study, we repurposed the Majorana Demonstrator, an experimental search for the neutrinoless double-beta decay of ^{76}Ge using an array of high-purity germanium detectors, to search for the decay of ^{180m}Ta. More than 17 kg, the largest amount of tantalum metal ever used for such a search, was installed within the ultralow-background detector array. In this Letter, we present results from the first year of Ta data taking and provide an updated limit for the ^{180m}Ta half-life on the different decay channels. With new limits up to 1.5×10^{19}  yr, we improved existing limits by 1-2 orders of magnitude which are the most sensitive searches for a single β and electron capture decay ever achieved. Over all channels, the decay can be excluded for T_{1/2}<0.29×10^{18}  yr.

Analysis of the Status and Future Direction for Digital Therapeutics in Children and Adolescent Psychiatry

Digital therapeutics based on software, such as artificial intelligence, virtual reality, games, and smartphone applications, are in the spotlight as new therapeutic alternatives in child and adolescent psychiatry. It draws attention to overcoming conventional therapeutics' limitations, such as toxicity, cost, and accessibility, and encourages patients to participate in the treatment attractively. The growth potential of the digital therapeutics market for psychiatric disorders in children and adolescents in Korea and abroad has been highlighted. Clinical studies and Food and Drug Administration approvals for digital therapeutics have increased, and cases approved by the Ministry of Food and Drug Safety have emerged in Korea. As seen above, digital transformation in child and adolescent psychiatry will change treatment paradigms significantly. Therefore, as this new field has just begun to emerge, it is necessary to verify the effectiveness and scope of the application of digital therapeutics and consider preparing a compensation system and institutional arrangements. Accordingly, this study analyzed the development trends and application status of digital therapeutics in children and adolescents and presented limitations and development directions from the perspective of application in healthcare. Further, the study is expected to identify the utility and limitations of digital therapeutics for children and adolescents and establish effective application measures.

Erratum: Search for Spontaneous Radiation from Wave Function Collapse in the Majorana Demonstrator [Phys. Rev. Lett. 129, 080401 (2022)]

This corrects the article DOI: 10.1103/PhysRevLett.129.080401.

Indirect Decompression of Osteoporotic Vertebral Compression Fracture Using Intraoperative Motor Evoked Potential Monitoring-Guided Ligamentotaxis

Osteoporotic vertebral compression fractures have become common in aging societies and can lead to a decreased quality of life with severe back pain and neurological deficits. Traditional direct decompression and stabilization surgeries can produce sufficient decompression and provide good results. However, after surgical treatment, some elderly patients with numerous chronic diseases often experience severe postoperative complications owing to the long surgery duration and massive bleeding. Therefore, to prevent perioperative morbidity, other surgical methods that simplify the surgical process and reduce the operation time are required. Herein, we describe a case of indirect decompression using ligamentotaxis and sequential anabolic agents. To examine their effectiveness during surgery, we monitored intraoperative motor-evoked potentials. The patient's neurological symptoms improved postoperatively. After the operation, the anabolic agent "romosozumab" was injected monthly to treat osteoporosis, prevent additional fractures, and accelerate posterolateral fusion. On serial follow-up, the anterior body height of the fractured vertebra improved significantly, demonstrating the importance of osteoporosis treatment using anabolic agents. Indirect decompression surgery may have early effects, whereas sequential anabolic agent use may consolidate the long-term effects of surgical treatment.

Exploring the Potential of Pulse Transit Time as a Biomarker for Sleep Efficiency through a Comparison Analysis with Heart Rate and Heart Rate Variability

The relationship between sleep dynamics and blood pressure (BP) changes is well established. Moreover, sleep efficiency and wakefulness during sleep (WASO) events have a significant impact on BP dipping. Despite this knowledge, there is limited research on the measurement of sleep dynamics and continuous blood pressure (CBP). This study aims to explore the relationship between sleep efficiency and cardiovascular function indicators such as pulse transit time (PTT), as a biomarker of CBP, and heart rate variability (HRV), measured using wearable sensors. The results of the study conducted on 20 participants at the UConn Health Sleep Disorders Center suggest a strong linear relationship between sleep efficiency and changes in PTT (r² = 0.8515) and HRV during sleep (r² = 5886). The findings of this study contribute to our understanding of the relationship between sleep dynamics, CBP, and cardiovascular health.

Continuous physiological signal measurement over 24-hour periods to assess the impact of work-related stress and workplace violence

Work-related stress has long been recognized as an essential factor affecting employees' health and wellbeing. Repeated exposure to acute occupational stressors puts workers at high risk for depression, obesity, hypertension, and early death. Assessment of the effects of acute stress on workers' wellbeing usually relies on subjective self-reports, questionnaires, or measuring biometric and biochemical markers in long-cycle time intervals. This study aimed to develop and validate the use of a multiparameter wearable armband for continuous non-invasive monitoring of physiological states. Two worker populations were monitored 24 h/day: six loggers for one day and six ICU nurses working 12-hr shifts for one week. Stress responses in nurses were highly correlated with changes in heart rate variability (HRV) and pulse transit time (PTT). A rise in the low-to high-frequency (LF/LH) ratio in HRV was also coincident with stress responses. HRV on workdays decreased compared to non-work days, and PTT also exhibited a persistent decrease reflecting increased blood pressure. Compared to loggers, nurses were involved in high-intensity work activities 45% more often but were less active on non-work days. The wearable technology was well accepted by all worker participants and yielded high signal quality, critical factors for long-term non-invasive occupational health monitoring.

Charge Injection Enhancement Comparisons of Iridium Oxide Microelectrodes In Vitro and In Vivo Using a Portable Neurostimulator

Microelectrodes are desired to deliver more charges to neural tissues while under electrochemical safety limits. Applying anodic bias potential during neurostimulation is a known technique for charge enhancement. Here, we investigated the levels of charge enhancement with anodic bias potential in vitro and in vivo using a custom-designed portable neurostimulator. We immersed our custom microelectrode probe in saline and measured voltage transients in response to constant current stimulation with and without a 500 mV anodic bias potential. We then inserted the same microelectrode probe into the primary motor cortex of the rat brain and measured voltage transients with the same electronics. Results showed that the charge injection capacity of the activated iridium oxide microelectrode site (with 2000 μm2 geometric surface areas (GSAs)) increased by the use of the anodic bias potentials in both in vitro and in vivo: from 10 nC/phase to 32 nC/phase for 200 μs pulse widths, and from 2 nC/phase to 8 nC/phase, respectively. Thus, the order of charge injection capacities of the four cases tested in this study is as follows (from the lowest to the highest): in vivo without anodic bias, in vivo with anodic bias, in vitro without anodic bias, and in vitro with anodic bias. This work also validated in vivo use of our new portable neurostimulator which received stimulation waveforms wirelessly.

Heterogeneous Structure Omnidirectional Strain Sensor Arrays With Cognitively Learned Neural Networks

Mechanically stretchable strain sensors gain tremendous attention for bioinspired skin sensation systems and artificially intelligent tactile sensors. However, high-accuracy detection of both strain intensity and direction with simple device/array structures is still insufficient. To overcome this limitation, an omnidirectional strain perception platform utilizing a stretchable strain sensor array with triangular-sensor-assembly (three sensors tilted by 45°) coupled with machine learning (ML) -based neural network classification algorithm, is proposed. The strain sensor, which is constructed with strain-insensitive electrode regions and strain-sensitive channel region, can minimize the undesirable electrical intrusion from the electrodes by strain, leading to a heterogeneous surface structure for more reliable strain sensing characteristics. The strain sensor exhibits decent sensitivity with gauge factor (GF) of ≈8, a moderate sensing range (≈0-35%), and relatively good reliability (3000 stretching cycles). More importantly, by employing a multiclass-multioutput behavior-learned cognition algorithm, the stretchable sensor array with triangular-sensor-assembly exhibits highly accurate recognition of both direction and intensity of an arbitrary strain by interpretating the correlated signals from the three-unit sensors. The omnidirectional strain perception platform with its neural network algorithm exhibits overall strain intensity and direction accuracy around 98% ± 2% over a strain range of ≈0-30% in various surface stimuli environments.

Final Result of the Majorana Demonstrator's Search for Neutrinoless Double-β Decay in ^{76}Ge

The Majorana Demonstrator searched for neutrinoless double-β decay (0νββ) of ^{76}Ge using modular arrays of high-purity Ge detectors operated in vacuum cryostats in a low-background shield. The arrays operated with up to 40.4 kg of detectors (27.2 kg enriched to ∼88% in ^{76}Ge). From these measurements, the Demonstrator has accumulated 64.5 kg yr of enriched active exposure. With a world-leading energy resolution of 2.52 keV FWHM at the 2039 keV Q_{ββ} (0.12%), we set a half-life limit of 0νββ in ^{76}Ge at T_{1/2}>8.3×10^{25}  yr (90% C.L.). This provides a range of upper limits on m_{ββ} of (113-269) meV (90% C.L.), depending on the choice of nuclear matrix elements.

When patients teach students empathy: a systematic review of interventions for promoting medical student empathy

BACKGROUND

Despite growing emphasis on empathic care, numerous studies demonstrate diminishing empathy in medical students. Involving patient educators in medical curricula may be a solution. Therefore, we conducted a systematic review to evaluate patient-involved interventions that promote empathy among medical students.

METHOD

A literature search of MEDLINE, Embase, PsycINFO, and ERIC databases was performed using the keywords "empathy," "medical student," and their synonyms. Results were independently screened in duplicate. Conflicts were resolved by group consensus. All English studies describing interventions that promote empathy in medical students engaging patient educators were included. Relevant data was extracted and summarized.

RESULTS

1467 studies were screened. 14 studies were included, of which 10 were pilot studies. Studies included patient involved interventions such as storytelling (5/14), shadowing patients (3/14), recorded videos (3/14), or combinations of methods (3/14). Qualitative measurements of empathy included written feedback and group discussions. Quantitative measurements included validated scales measuring empathy. All studies demonstrated increase in empathy among medical students. Participants reported satisfaction with training and patients reported being proud of giving back by training future physicians.

CONCLUSION

Interventions engaging patient educators were shown to have a positive impact on medical student empathy. Furthermore, patient-led education was shown to increase medical student understanding of subject and knowledge retention while empowering patients. Further implementation of patient-involved education is an important step forward in patient-partnered care and may identify additional advantages of patient engagement in medical education.

A portable neurostimulator circuit with anodic bias enhances stimulation injection capacity

OBJECTIVE

Electrochemically safe and efficient charge injection for neural stimulation necessitates monitoring of polarization and enhanced charge injection capacity of the stimulating electrodes. In this work, we present improved microstimulation capability by developing a custom-designed multichannel portable neurostimulator with a fully programmable anodic bias circuitry and voltage transient monitoring feature.

APPROACH

We developed a sixteen-channel multichannel neurostimulator system, compared charge injection capacities as a function of anodic bias potentials, and demonstrated convenient control of the system by a custom-designed user interface allowing bidirectional wireless data transmission of stimulation parameters and recorded voltage transients. Charge injections were conducted in phosphate-buffered saline with silicon-based iridium oxide microelectrodes.

MAIN RESULTS

Under charge-balanced 200 µs cathodic first pulsing, the charge injection capacities increased proportionally to the level of anodic bias applied, reaching a maximum of ten-fold increase in current intensity from 10 µA (100 µC/cm2) to 100 µA (1000 µC/cm2) with a 600 mV anodic bias. Our custom-designed and completely portable sixteen-channel neurostimulator enabled a significant increase in charge injection capacity in vitro.

SIGNIFICANCE

Limited charge injection capacity has been a bottleneck in neural stimulation applications, and our system may enable efficacious behavioral animal study involving chronic microstimulation while ensuring electrochemical safety.

Search for Spontaneous Radiation from Wave Function Collapse in the Majorana Demonstrator

The Majorana Demonstrator neutrinoless double-beta decay experiment comprises a 44 kg (30 kg enriched in ^{76}Ge) array of p-type, point-contact germanium detectors. With its unprecedented energy resolution and ultralow backgrounds, Majorana also searches for rare event signatures from beyond standard model physics in the low energy region below 100 keV. In this Letter, we test the continuous spontaneous localization (CSL) model, one of the mathematically well-motivated wave function collapse models aimed at solving the long-standing unresolved quantum mechanical measurement problem. While the CSL predicts the existence of a detectable radiation signature in the x-ray domain, we find no evidence of such radiation in the 19-100 keV range in a 37.5 kg-y enriched germanium exposure collected between December 31, 2015, and November 27, 2019, with the Demonstrator. We explored both the non-mass-proportional (n-m-p) and the mass-proportional (m-p) versions of the CSL with two different assumptions: that only the quasifree electrons can emit the x-ray radiation and that the nucleus can coherently emit an amplified radiation. In all cases, we set the most stringent upper limit to date for the white CSL model on the collapse rate, λ, providing a factor of 40-100 improvement in sensitivity over comparable searches. Our limit is the most stringent for large parts of the allowed parameter space. If the result is interpreted in terms of the Diòsi-Penrose gravitational wave function collapse model, the lower bound with a 95% confidence level is almost an order of magnitude improvement over the previous best limit.

Search for Solar Axions via Axion-Photon Coupling with the Majorana Demonstrator

Axions were originally proposed to explain the strong-CP problem in QCD. Through axion-photon coupling, the Sun could be a major source of axions, which could be measured in solid state detection experiments with enhancements due to coherent Primakoff-Bragg scattering. The Majorana Demonstrator experiment has searched for solar axions with a set of ^{76}Ge-enriched high purity germanium detectors using a 33 kg-yr exposure collected between January, 2017 and November, 2019. A temporal-energy analysis gives a new limit on the axion-photon coupling as g_{aγ}<1.45×10^{-9}  GeV^{-1} (95% confidence level) for axions with mass up to 100  eV/c^{2}. This improves laboratory-based limits between about 1  eV/c^{2} and 100  eV/c^{2}.

Results from the Baksan Experiment on Sterile Transitions (BEST)

The Baksan Experiment on Sterile Transitions (BEST) was designed to investigate the deficit of electron neutrinos ν_{e} observed in previous gallium-based radiochemical measurements with high-intensity neutrino sources, commonly referred to as the "gallium anomaly," which could be interpreted as evidence for oscillations between ν_{e} and sterile neutrino (ν_{s}) states. A 3.414-MCi ^{51}Cr ν_{e} source was placed at the center of two nested Ga volumes and measurements were made of the production of ^{71}Ge through the charged current reaction, ^{71}Ga(ν_{e},e^{-})^{71}Ge, at two average distances. The measured production rates for the inner and the outer targets, respectively, are [54.9_{-2.4}^{+2.5}(stat)±1.4(syst)] and [55.6_{-2.6}^{+2.7}(stat)±1.4(syst)] atoms of ^{71}Ge/d. The ratio (R) of the measured rate of ^{71}Ge production at each distance to the expected rate from the known cross section and experimental efficiencies are R_{in}=0.79±0.05 and R_{out}=0.77±0.05. The ratio of the outer to the inner result is 0.97±0.07, which is consistent with unity within uncertainty. The rates at each distance were found to be similar, but 20%-24% lower than expected, thus reaffirming the anomaly. These results are consistent with ν_{e}→ν_{s} oscillations with a relatively large Δm^{2} (>0.5  eV^{2}) and mixing sin^{2}2θ (≈0.4).

α -event characterization and rejection in point-contact HPGe detectors

P-type point contact (PPC) HPGe detectors are a leading technology for rare event searches due to their excellent energy resolution, low thresholds, and multi-site event rejection capabilities. We have characterized a PPC detector's response to α particles incident on the sensitive passivated and p + surfaces, a previously poorly-understood source of background. The detector studied is identical to those in the Majorana Demonstrator experiment, a search for neutrinoless double-beta decay ( 0 ν β β ) in 76 Ge. α decays on most of the passivated surface exhibit significant energy loss due to charge trapping, with waveforms exhibiting a delayed charge recovery (DCR) signature caused by the slow collection of a fraction of the trapped charge. The DCR is found to be complementary to existing methods of α identification, reliably identifying α background events on the passivated surface of the detector. We demonstrate effective rejection of all surface α events (to within statistical uncertainty) with a loss of only 0.2% of bulk events by combining the DCR discriminator with previously-used methods. The DCR discriminator has been used to reduce the background rate in the 0 ν β β region of interest window by an order of magnitude in the Majorana Demonstrator  and will be used in the upcoming LEGEND-200 experiment.

Simulator acceleration and inverse design of fin field-effect transistors using machine learning

The simulation and design of electronic devices such as transistors is vital for the semiconductor industry. Conventionally, a device is intuitively designed and simulated using model equations, which is a time-consuming and expensive process. However, recent machine learning approaches provide an unprecedented opportunity to improve these tasks by training the underlying relationships between the device design and the specifications derived from the extensively accumulated simulation data. This study implements various machine learning approaches for the simulation acceleration and inverse-design problems of fin field-effect transistors. In comparison to traditional simulators, the proposed neural network model demonstrated almost equivalent results (R² = 0.99) and was more than 122,000 times faster in simulation. Moreover, the proposed inverse-design model successfully generated design parameters that satisfied the desired target specifications with high accuracies (R² = 0.96). Overall, the results demonstrated that the proposed machine learning models aided in achieving efficient solutions for the simulation and design problems pertaining to electronic devices. Thus, the proposed approach can be further extended to more complex devices and other vital processes in the semiconductor industry.

Preliminary Analysis of the Risk Factor Identification Embedding Model for Cardiovascular Disease

Cardiovascular Disease (CVD) is responsible for a large part of healthcare costs every year, but susceptibility to it is affected by complex biological and physiological variables including patients' genetics and lifestyles. There has not been much work to develop a framework that incorporates these important and clinically relevant risk factors into a comprehensive model for CVD research. Moreover, the data labeling required to do so, such as annotating gene functions, is an extremely challenging, tedious, and time-consuming process. In this work, our goal was to develop and validate a risk factor embedding model, which incorporates genotype, phenotype without pre-labeled information to identify various risk factors of CVD. We hypothesize that (1) the knowledge background that does not require data labeling could be gathered from published abstract data, (2) the phenotype, genotype risk factors could be represented in an embedding vector space. We collected 1,363,682 published abstracts from PubMed using the keyword "heart" and 19,264 human gene names, then trained our model using the collected abstracts. We evaluated our CVD risk factor identification model using both intrinsic and extrinsic evaluations: for the intrinsic evaluation, we examined whether or not the captured top-10 words and genes have references related to the input query "myocardial infarction", as one of CVDs, and our model correctly identified them. For the extrinsic evaluation, we used our model to the dimensionality reduction task for classifications, and our method outperformed other popular methods. These results show the feasibility of our approach for disease-associated risk factors of CVD which incorporates genotype, phenotype.Clinical Relevance-Our model provides a comprehensive tool to incorporate various risk factors without any a priori data labeling knowledge for CVD. Our approach shows a potential to provide discovered knowledge that contributes to better understanding and treatment of CVD.

Occupational Safety and Health Education Experience and Prevention Service Needs among South Korean Farmers: A National Survey

OBJECTIVE

Objective data on farmers' awareness of occupational safety and health are needed for the development of national policy measures. Yet, relevant research is lacking in South Korea.

METHODS

This study investigated occupational safety and health education experience, perceived needs for prevention services, and factors affecting these among South Korean farmers. The data are from a personal-visit survey conducted on 9,970 sample farms nationwide.

RESULTS

While 69.9% of the farmers felt the need for agricultural health and safety education and 60.6% were willing to receive it, only 30.3% had at least one educational experience. A total of 51.9% felt the need for professional on-farm services. By group, education experience and perceived need for prevention services were consistently low among women, people aged 70 or older, low-income individuals, or farmers with a farming career duration of less than five years. Experience of safety and health education increased the desire for other prevention services: people who had received safety and health education were 6.4 times more likely to feel the need for education, 5.5 times more willing to participate in education, 2.0 times more likely to feel the need to improve their work environments, and 1.7 times more likely to feel the need for professional on-farm services.

CONCLUSION

Despite the high desire for injury prevention services, farmers have had very limited opportunities to receive safety education; measures are also needed for groups whose safety education has been neglected. Further studies on education methods and on-farm services tailored to South Korean farmers are needed.

Wide-range Motion Recognition through Insole Sensor using Multi-walled Carbon Nanotubes and Polydimethylsiloxane Composites

High linearity/sensitivity and a wide dynamic sensing range are the most desirable features for pressure sensors to accurately detect and respond to external pressure stimuli. Even though a number of recent studies have demonstrated a low-cost pressure sensing device for a smart insole system by using scalable and deformable conductive materials, they still lack stretchability and desirable properties such as high sensitivity, hysteresis, linearity, and fast response time to obtain accurate and reliable data. To resolve this issue, a flexible and stretchable piezoresistive pressure sensor with high linear response over a wide pressure range is developed and integrated in a wearable insole system. The sensor uses multi-walled carbon nanotubes and polydimethylsiloxane (MWCNT/PDMS) composites with gradient density double-stacked configuration as well as randomly distributed surface microstructure (RDSM). The randomly distributed surface of the MWCNT/PDMS composite is easily and non-artificially generated by the evaporation of residual IPA solvent during a composite curing process. Due to two functional features consisting of the double-stacked composite configuration with different gradient MWCNT density and RDSM, the pressure sensor shows high linear sensitivity (~82.5 kPa) and a pressure range of 0-1 MPa, providing extensive potential applications in monitoring human motions. Moreover, for a practical wearable application detecting the users real-time motions, a custom-designed output signal acquisition system has been developed and integrated with the insole pressure sensor. As a result, the insole sensor can successfully detect walking, running, and jumping movements and can be used in daily life to monitor gait patterns by virtue of its long-term stability.

Clinical and electrophysiological characteristics of extra-pulmonary vein triggers in patients who underwent catheter ablation for atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

Extra-pulmonary vein (PV) triggers play significant roles in atrial fibrillation (AF) recurrence after AF catheter ablation (AFCA).

Purpose

We explore the clinical and electrophysiological characteristics of extra-PV triggers in de novo and repeat-AFCA procedure.

Methods

We included 2,151 patients who had de novo AFCA and 319 repeat AFCA (female 28.0%, 59.1 ± 10.8 years old, paroxysmal AF 65.1%) those underwent post-procedural isoproterenol (ISO) provocation tests. We analysed the clinical, electrophysiological, and procedure-related factors associated with extra-PV triggers.

Results

Extra-PV triggers were documented in 11.9% (1.19 ± 0.42 foci) after de novo-AFCA and 27.0% (1.37 ± 0.65 foci) after repeat-AFCA (p = 0.004). LA volume index (OR 1.02 [1.01-1.03], p = 0.004), history of vascular disease (OR 0.55[0.31-0.91], p = 0.028) and Lead I amplitude of electrocardiogram (OR &lt;0.01 [&lt;0.01-0.62], p = 0.032) were independently associated with the existence of extra-PV triggers in de-novo procedure. Women (OR 1.84 [1.03-3.25], p = 0.037) and LA appendage volume (OR 1.04 [1.01-1.07] p = 0.027) were independently associated with extra-PV triggers during the redo-mapping procedure. Septum (28.4%), coronary sinus (24.0%), and superior vena cava (19.6%) were common extra-PV foci, and septal foci were more commonly found in repeat mapping (38.4% vs. 25.0%, p = 0.025). Among 65 patients who showed extra-PV at the repeat procedures, 19 (29.2%) matched with previous focal or empirical extra-PV ablation sites and 9 (13.8%) were multiple or unmappable sites. AF recurrence rates were significantly higher in both patients with extra-PV triggers after de novo procedures (Log-rank P &lt;0.001; HR 1.93 [1.58-2.36], p= &lt;0.001) and repeat procedures (Log-rank P &lt;0.001, HR 1.87 [1.29-2.70], p= &lt;0.001).

Conclusion

ISO provoked extra-PV triggers commonly found in AF patients with significant remodelling and previous empirical or focal extra-PV ablations. Existence of extra-PV triggers were independently associated with poorer rhythm outcome after both de novo and repeat AFCA. Denovo AF ablation outcome OverallExtra-PV triggers (-)Extra-PV triggers (+)p-value(n = 2151)(n = 1895)(n = 256)Age, yrs58.98 ± 10.9558.73 ± 11.0360.76 ± 10.200.006Male, (%)1550 ( 72.1)1389 ( 73.3)161 ( 62.9)0.001Follow up duration, month50.30 (37.71)51.65 (37.95)40.71 (34.58)&lt;0.001Early recurrence (%)579 ( 27.8)455 ( 24.9)124 ( 48.4)&lt;0.001Clinical recurrence (%)699 ( 33.6)584 ( 32.0)115 ( 44.9)&lt;0.001Abstract Figure. AF free survival according to Extra PVT

Sympathetic predominance before tourniquet deflation is associated with a reduction in arterial blood pressure after tourniquet deflation during total knee arthroplasty

High dependency of arterial blood pressure (ABP) on enhanced sympathetic activity, which maintains vascular tone, leads to hypotension after hemodynamic insults that blunt the sympathetic activity. Therefore, we hypothesized that sympathovagal balance before tourniquet deflation (TD) determines the extent of a reduction in ABP after TD during total knee arthroplasty (TKA). Fifty-four hypertensive female patients undergoing TKA under spinal anesthesia were analyzed. The sympathovagal balance [low-to-high frequency ratio of heart rate variability (LF/HF)] before TD was defined as (LF/HF during 5 min before TD-preanesthetic LF/HF)/preanesthetic LF/HF (%). An increase in its value represents a shift in sympathovagal balance toward sympathetic predominance. The percent change in the mean ABP (MAP) after TD was defined as (minimum MAP during 10 min after TD-averaged MAP during 5 min before TD)/averaged MAP during 5 min before TD (%). Simple linear regression was performed to assess the correlation between the sympathovagal balance before TD and change in MAP after TD. The correlation was also assessed by multiple linear regression controlling for age, duration of tourniquet inflation, and spinal anesthesia-induced hypotension. Thirty-two minutes (on average) after tourniquet inflation, the MAP was decreased by 12.1 (-3.0 to 47.9) % [mean (range)] upon TD (P<0.001). The sympathovagal balance before TD was negatively proportional to the change in MAP after TD in both simple and multiple linear regression models (R2=0.323 and 0.340, P<0.001). A shift in sympathovagal balance toward sympathetic predominance before TD is associated with a decrease in ABP after TD.

317 Why Are We Cancelling Theatre Cases at Ealing Hospital? What Can Be Done?

Introduction

Following a recent spate of on the day cancellation of elective operations being cancelled on the day of surgery, a need for a wider review was felt. Our aim was to identify the causes behind these cancellations.

Method

Retrospective data collection was performed to categorise patients according to the reason for cancellation. Analysis consisted of case presentations being prepared and presented to the surgical consultants.

Results

A total of 130 operations were cancelled on the day of surgery. 22 patients were cancelled due to the procedure not being required and 10 patients were cancelled due to insufficient pre-operative investigations.

Analysis of the 32 cases demonstrated that the majority of cancelled patients were seen and listed for surgery after clinical review by the registrar without involvement of the consultant.

Some cancellations occurred when the consultant responsible for listing the patient was different of the operating consultant.

Both factors lead to differences in opinion arising on the day of surgery.

Conclusions

Ensuring patients are only listed after discussion with the consultant would reduce cancellations arising from lack of experience and clinical misjudgment of the registrar. It would also ensure that cases added to the pooled operating lists are less subjective in their indication and readiness.

Maximizing Charge Injection Limits of Iridium Oxide Electrodes with a Programmable Anodic Bias Circuit

Efficacious stimulation of neural tissues requires high charge injection capacity while minimizing electrode polarization. Applying anodic bias on certain electrode materials is a way to enhance charge injection both in vitro and in vivo. We developed an embedded neurostimulator system that enabled a digital control of user-defined bias levels, without requiring a potentiometer or external voltage source. Comparison of charge injection with and without anodic-bias, as well as at different bias potentials were conducted in phosphate-buffered saline with Blackrock iridium oxide microelectrodes. Results showed that a nine-fold increase in current intensity and charge injection capacity, was achieved with a 0.7 V anodic bias and within electrochemically safe limits.

Liposomal irinotecan plus fluorouracil/leucovorin versus FOLFIRINOX as the second-line chemotherapy for patients with metastatic pancreatic cancer: a multicenter retrospective study of the Korean Cancer Study Group (KCSG)

Background

There is no clear consensus on the recommended second-line treatment for patients with metastatic pancreatic cancer who have disease progression following gemcitabine-based therapy. We retrospectively evaluated the clinical outcomes of liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (FL) and FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) in patients who had failed on the first-line gemcitabine-based therapy.

Patients and methods

From January 2015 to August 2019, 378 patients with MPC who had received nal-IRI/FL (n = 104) or FOLFIRINOX (n = 274) as second-line treatment across 11 institutions were included in this retrospective study.

Results

There were no significant differences in baseline characteristics between groups, except age and first-line regimens. With a median follow-up of 6 months, the median progression-free survival (PFS) was 3.7 months with nal-IRI/FL versus 4.6 months with FOLFIRINOX (P = 0.44). Median overall survival (OS) was 7.7 months with nal-IRI/FL versus 9.7 months with FOLFRINOX (P = 0.13). There was no significant difference in PFS and OS between the two regimens in the univariate and multivariate analyses. The subgroup analysis revealed that younger age (<70 years) was associated with better OS with FOLFIRINOX. In contrast, older age (≥70 years) was associated with better survival outcomes with nal-IRI/FL. Adverse events were manageable with both regimens; however, the incidence of grade 3 or higher neutropenia and peripheral neuropathy was higher in patients treated with FOLFIRINOX than with nal-IRI/FL.

Conclusions

Second-line nal-IRI/FL and FOLFIRINOX showed similar effectiveness outcomes after progression following first-line gemcitabine-based therapy. Age could be the determining factor for choosing the appropriate second-line therapy.

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This multicenter retrospective study investigated nal-IRI/FL and FOLFIRINOX outcomes after gemcitabine-based therapy.

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We found no significant differences in outcome between nal-IRI/FL and FOLFIRINOX treatment.

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Both regimens were well tolerated; however, neutropenia and peripheral neuropathy were more frequent with FOLFIRINOX.

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Age (cut-off, 70 years) showed differential efficacy between chemotherapy regimens.

Enhanced Interfacial Integrity of Amorphous Oxide Thin-Film Transistors by Elemental Diffusion of Ternary Oxide Semiconductors

Low-temperature solution-processed oxide semiconductor and dielectric films typically possess a substantial number of defects and impurities due to incomplete metal-oxygen bond formation, causing poor electrical performance and stability. Here, we exploit a facile route to improve the film quality and the interfacial property of low-temperature solution-processed oxide thin films via elemental diffusion between metallic ion-doped InO_x (M:InO_x) ternary oxide semiconductor and AlO_x gate dielectric layers. Particularly, it was revealed that metallic dopants such as magnesium (Mg) and hafnium (Hf) having a small ionic radius, a high Gibbs energy of oxidation, and bonding dissociation energy could successfully diffuse into the low-quality AlO_x gate dielectric layer and effectively reduce the structural defects and residual impurities present in the bulk and at the semiconductor/dielectric interface. Through an extensive investigation on the compositional, structural, and electrical properties of M:InO_x/AlO_x thin-film transistors (TFTs), we provide direct evidences of elemental diffusion occurred between M:InO_x and AlO_x layers as well as its contribution to the electrical performance and operational stability. Using the elemental diffusion process, we demonstrate solution-processed Hf:InO_x TFTs using a low-temperature (180 °C) AlO_x gate dielectric having a field-effect mobility of 2.83 cm² V^-1·s^-1 and improved bias stability. Based on these results, it is concluded that the elemental diffusion between oxide semiconductor and gate dielectric layers can play a crucial role in realizing oxide TFTs with enhanced structural and interfacial integrity.

Prospective, Randomized, Comparative, Multicenter Study of the Hybrid Ultrasonic Advanced Bipolar Device and the Ultrasonic Coagulating Shears in Open Thyroidectomy

Background. The hybrid ultrasonic advanced bipolar device (HUB) that integrates ultrasonic energy and advanced bipolar energy was recently developed and applied to thyroid surgery. The purpose of this study was to compare the efficacy and safety of HUB and ultrasonic coagulating shears for open thyroidectomy. Methods. A total of 200 patients were enrolled from April to September 2017 in this prospective, randomized, multicenter study. Patients were randomly assigned to an ultrasonic group (n = 101) or a hybrid group (n = 99). Results. Operation times were similar in the 2 study groups, that is, 54.2 ± 25.2 minutes in the ultrasonic group and 50.2 ± 21.6 minutes in the hybrid group. Postoperative surgical results and morbidities were no different in the 2 groups. However, the total amount of bleeding was significantly less in the hybrid group (13.0 ± 17.7 mg vs 8.6 ± 11.5 mg; P = .042). Conclusions. Our study showed that there was no significant difference between the 2 groups in postoperative surgical results and morbidity. The total bleeding amount was significantly less in the hybrid group. The study shows that HUB is comparable to the ultrasonic coagulating shears in terms of efficacy and safety during thyroid surgery.

Changes of Neurotransmitters in Youth with Internet and Smartphone Addiction: A Comparison with Healthy Controls and Changes after Cognitive Behavioral Therapy

BACKGROUND AND PURPOSE

Neurotransmitter changes in youth addicted to the Internet and smartphone were compared with normal controls and in subjects after cognitive behavioral therapy. In addition, the correlations between neurotransmitters and affective factors were investigated.

MATERIALS AND METHODS

Nineteen young people with Internet and smartphone addiction and 19 sex- and age-matched healthy controls (male/female ratio, 9:10; mean age, 15.47 ± 3.06 years) were included. Twelve teenagers with Internet and smartphone addiction (male/female ratio, 8:4; mean age, 14.99 ± 1.95 years) participated in 9 weeks of cognitive behavioral therapy. Meshcher-Garwood point-resolved spectroscopy was used to measure γ-aminobutyric acid and Glx levels in the anterior cingulate cortex. The γ-aminobutyric acid and Glx levels in the addicted group were compared with those in controls and after cognitive behavioral therapy. The γ-aminobutyric acid and Glx levels correlated with clinical scales of Internet and smartphone addiction, impulsiveness, depression, anxiety, insomnia, and sleep quality.

RESULTS

Brain parenchymal and gray matter volume-adjusted γ-aminobutyric acid-to-creatine ratios were higher in subjects with Internet and smartphone addiction (P = .028 and .016). After therapy, brain parenchymal- and gray matter volume-adjusted γ-aminobutyric acid-to-creatine ratios were decreased (P = .034 and .026). The Glx level was not statistically significant in subjects with Internet and smartphone addiction compared with controls and posttherapy status. Brain parenchymal- and gray matter volume-adjusted γ-aminobutyric acid-to-creatine ratios correlated with clinical scales of Internet and smartphone addictions, depression, and anxiety. Glx/Cr was negatively correlated with insomnia and sleep quality scales.

CONCLUSIONS

The high γ-aminobutyric acid levels and disrupted balance of γ-aminobutyric acid-to-Glx including glutamate in the anterior cingulate cortex may contribute to understanding the pathophysiology and treatment of Internet and smartphone addiction and associated comorbidities.

A Behavior-Learned Cross-Reactive Sensor Matrix for Intelligent Skin Perception

Mimicking human skin sensation such as spontaneous multimodal perception and identification/discrimination of intermixed stimuli is severely hindered by the difficulty of efficient integration of complex cutaneous receptor-emulating circuitry and the lack of an appropriate protocol to discern the intermixed signals. Here, a highly stretchable cross-reactive sensor matrix is demonstrated, which can detect, classify, and discriminate various intermixed tactile and thermal stimuli using a machine-learning approach. Particularly, the multimodal perception ability is achieved by utilizing a learning algorithm based on the bag-of-words (BoW) model, where, by learning and recognizing the stimulus-dependent 2D output image patterns, the discrimination of each stimulus in various multimodal stimuli environments is possible. In addition, the single sensor device integrated in the cross-reactive sensor matrix exhibits multimodal detection of strain, flexion, pressure, and temperature. It is hoped that his proof-of-concept device with machine-learning-based approach will provide a versatile route to simplify the electronic skin systems with reduced architecture complexity and adaptability to various environments beyond the limitation of conventional "lock and key" approaches.

Preparation and characterization of positively surface charged zinc oxide nanoparticles against bacterial pathogens

Solvothermal synthesis was used to investigate the formation of zinc oxide (ZnO) nanoparticles (NPs). A series of ZnO NPs was synthesized with different relative ratios of didodecyldimethylammonium bromide (DDAB) and zinc nitrate (ZN). The variation in the molarity influenced the crystallinity, size, and morphology of the obtained ZnO NPs. X-ray diffraction, Fourier-transform infrared spectroscopy, field-emission scanning electron microscopy, high-resolution transmission electron microscopy, and zeta potential analysis were used to study the characteristic features of the ZnO NPs. The ZnO surface charge, size, and morphological structure were highly reliant on the concentrations of DDAB and ZN. With increasing relative ratio of DDAB to ZN, the particle size of ZnO NPs decreased and the surface charge increased to higher positive value. The ZnO NPs synthesized with cationic liquid DDAB presented enhanced performance in preventing the growth of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) strains. The antibacterial activity of ZnO NPs have direct contact with the microbial cell wall resulting in destruction of bacterial cell integrity, release of antimicrobial Zn²⁺ ions, and induce cell death. This is due to the positively charged smaller ZnO NPs, prepared with DDAB cationic surfactant, effectively acting as an antimicrobial agent against food-borne pathogenic bacteria.

A Wireless Neurostimulator System with an Embedded ARM™ Microprocessor

In this study, a novel multi-layer printed circuit board (PCB)-based neurostimulator system with an embedded microprocessor is presented for applications in neuroprosthesis. The system integrates rechargeable batteries, a power management block, adjustable constant-current waveforms, voltage transient monitoring, and evoked neural response recording. The system can be configured to select channels among the 16 stimulation channels via Bluetooth communication wirelessly. Bench top measurements demonstrated that the system generated biphasic current waveforms with various stimulation parameters with approximately 407 mW of power consumption. Additional testing and validation with microelectrodes are underway.

Enhanced antimicrobial stewardship based on rapid phenotypic antimicrobial susceptibility testing for bacteraemia in patients with haematological malignancies: a randomized controlled trial

OBJECTIVES

Recently, rapid phenotypic antimicrobial susceptibility testing (AST) based on microscopic imaging analysis has been developed. The aim of this study was to determine whether implementation of antimicrobial stewardship programmes (ASP) based on rapid phenotypic AST can increase the proportion of patients with haematological malignancies who receive optimal targeted antibiotics during early periods of bacteraemia.

METHODS

This randomized controlled trial enrolled patients with haematological malignancies and at least one positive blood culture. Patients were randomly assigned 1:1 to conventional (n = 60) or rapid phenotypic (n = 56) AST. The primary outcome was the proportion of patients receiving optimal targeted antibiotics 72 hr after blood collection for culture.

RESULTS

The percentage receiving optimal targeted antibiotics at 72 hr was significantly higher in the rapid phenotypic AST group (45/56, 80.4%) than in conventional AST group (34/60, 56.7%) (relative risk (RR) 1.42, 95% confidence interval (CI) 1.09-1.83). The percentage receiving unnecessary broad-spectrum antibiotics at 72 hr was significantly lower (7/26, 12.5% vs 18/60, 30.0%; RR 0.42, 95% CI 0.19-0.92) and the mean time to optimal targeted antibiotic treatment was significantly shorter (38.1, standard deviation (SD) 38.2 vs 72.8, SD 93.0 hr; p < 0.001) in the rapid phenotypic AST group. The mean time from blood collection to the AST result was significantly shorter in the rapid phenotypic AST group (48.3, SD 17.6 vs 83.1, SD 22.2 hr).

DISCUSSION

ASP based on rapid phenotypic AST can rapidly optimize antibiotic treatment for bacteraemia in patients with haematological malignancy. Rapid phenotypic AST can improve antimicrobial stewardship in immunocompromised patients.