Nygaardcoughlin4480
Such light-controlled properties enabled the device to operate as a self-powered photodetector with outstanding responsivity (∼129.2 V/mW), rapid response time (∼50 ms), and satisfactory detectivity (∼1.4 × 1010 Jones) in the piezoelectric mode. The same device could also operate as a pressure sensor that exhibited excellent pressure sensitivity values of 0.107 and 0.194 V/kPa in the piezoelectric and triboelectric modes, respectively. In addition, the device exhibits a fast response time with long-term on-off switching properties, excellent mechanical durability, and long-term stability.Fibers that can reversibly and passively change colors along with body temperatures are highly desired for potential applications including temperature sensors, smart wearables, and photonic devices. Here, we develop a facile strategy to fabricate thermochromic photonic fibers, which could exhibit tunable structural colors as a function of temperatures. The thermochromic fibers are prepared by aligning superparamagnetic, carbon-encapsulated Fe3O4 colloidal nanocrystal clusters (Fe3O4@C CNCs) in a thermoresponsive hydrogel, poly(N-isopropylacrylamide) (PNIPAM), forming chain-like structures under an external magnetic field before gelation. When the fiber is transferred from air to water at room temperature, it changes color from dark green to red as it swells. The red color can be reversibly changed back to green as the temperature is raised to 36 °C, while the fiber shrinks and the reflection peak shifts from 642 to 494 nm. The swelling of the fiber is anisotropic by 60% in the diameter direction but 45% in the length direction. Therefore, the fiber can act as a thermochromic actuator.
Although the outcome of kidney transplantation (KTx) has improved, various adverse effects of immunosuppressants and chronic rejection aggravate the long-term prognosis of patients. Therefore, the induction of immune tolerance may be an effective therapeutic strategy.
A clinical trial aiming at immune tolerance induction was conducted in kidney transplant recipients from HLA mismatched living donors by infusing autologous donor-specific regulatory T cells (Treg). To obtain Treg, recipient's peripheral blood mononuclear cells were cocultured with irradiated donor cells in the presence of anti-CD80/CD86 monoclonal antibody for 2 weeks. For preconditioning, splenectomy + cyclophosphamide (CP) was employed in the first series (group A; n = 9). In group B, splenectomy was substituted by preadministration of rituximab (group B; n = 3). In the latest cases, rituximab + rabbit antithymocyte globulin was administered instead of cyclophosphamide (group C; n = 4). Twelve days after KTx, the cultured cells were intravenously infused, and immunosuppressants were gradually tapered thereafter.
Although mixed lymphocyte reaction was remarkably suppressed in a donor-specific fashion, 6 out of 9 patients from group A, 1 out of 3 from group B, and 1 out of 4 from group C developed acute rejection within 1 year after KTx. Complete cessation of immunosuppression was not achieved, and a small dose of immunosuppressants was continued.
The adoptive transfer of autologous ex vivo-expanded Treg is 1 of the options to possibly induce alloimmune hyporesponsiveness. However, in the present study, further regimen optimization is still required and should be the focus of future investigations.
The adoptive transfer of autologous ex vivo-expanded Treg is 1 of the options to possibly induce alloimmune hyporesponsiveness. However, in the present study, further regimen optimization is still required and should be the focus of future investigations.
Burnout is a problem among physicians. Debriefing may be a tool to decrease burnout and increase resiliency in pediatric emergency medicine (PEM) providers. The objective of this study was to determine rates of burnout and resiliency in PEM fellows and their experience with debriefing.
A validated survey was administered to PEM fellows during their first and then third years of fellowship. The survey included the abbreviated Maslach Burnout Index (MBI), the Brief Resilience Scale (BRS), and debriefing experience. The percent of respondents with moderate to high burnout was determined by their scores in each of 3 MBI categories. Their resilience was determined by the BRS score. The effect of debriefing on resiliency scores was analyzed.
There were 47 first-year respondents (of 148 first-year PEM fellows) and 34 third-year respondents (of 118 third-year PEM fellows). check details There were burnout scores in at least 1 MBI category in 80.9% of first years and 65% of third years. In first years, 42.6% showed burnout in personal accomplishment, 38.3% in depersonalization, and 55.3% in emotional exhaustion. By third year, they were 35.3%, 29.4%, and 52.9%, respectively. About 59% of first and third years had low resiliency scores. Fifty-five percent of first year respondents felt comfortable with debriefing compared with 67.6% of third years. The fellows' comfort and experience with debriefing did not significantly affect their BRS score.
This study shows that many first-year PEM fellows already have signs of burnout and low resiliency. However, by third year, there was improvement in burnout scores. Additional tools provided in fellowship may help prevent burnout in PEM fellows.
This study shows that many first-year PEM fellows already have signs of burnout and low resiliency. However, by third year, there was improvement in burnout scores. Additional tools provided in fellowship may help prevent burnout in PEM fellows.
Fever in the setting of neutropenia is a potentially life-threatening complication of cancer treatment. A time of less than 60 minutes from presentation to antibiotic administration is therefore recommended.
To use Lean Six Sigma methodology, a quality improvement initiative, to improve time to antibiotics (TTA) for children with chemotherapy-induced febrile neutropenia presenting to the emergency department.
Lean Six Sigma is a quality improvement method that engages all impacted stakeholders and focuses on streamlining the process by removing process wastes. Stakeholders identified multiple process wastes in an in-depth study of 49 fever episodes in patients attending a tertiary care pediatric hospital, including patients waiting to be registered, waiting for laboratory technicians, delay in accessing central venous access device, waiting for absolute neutrophil count, and delayed antibiotics orders. We implemented multiple solutions engaging patients in the process through predischarge tours of the emergency department, home application of topical anesthetic, nurse-initiated pathway, early access of central venous access device for all blood work, and planned antibiotic administration no later than 45 minutes after triage.
