Danieldonaldson2191

2 months (95% CI 3.6-4.9); 84 patients (49%) harbored targetable mutations. Among bevacizumab-naïve patients with MRI and CSF cytology at time of LC-LM diagnosis, extent of radiographic involvement correlated with risk of death (hazard ratio [HR] 1.16; 95% CI 1.02-1.33; P = 0.03), as did CSF CTC (HR 3.39, 95% CI 1.01-11.37; P = 0.048) and CSF cfDNA concentration (HR 2.58; 95% CI 0.94-7.05; P = 0.06). Those without a targetable mutation were almost 50% more likely to die (HR 1.49; 95% CI 1.06-2.11; P = 0.02). CONCLUSIONS Extent of radiographic involvement and quantification of CSF CTC and cfDNA show promise as prognostic indicators. These findings support molecular characterization and staging for clinical management, prognostication, and clinical trial stratification of LC-LM. © The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.Deep brain stimulation is effective for patients with treatment-refractory obsessive-compulsive disorder. Deep brain stimulation of the ventral anterior limb of the internal capsule rapidly improves mood and anxiety with optimal stimulation parameters. To understand these rapid effects, we studied functional interactions within the affective amygdala circuit. We compared resting state functional MRI data during chronic stimulation versus 1 week of stimulation discontinuation in patients, and obtained two resting state scans from matched healthy volunteers to account for test-retest effects. Imaging data were analysed using functional connectivity analysis and dynamic causal modelling. Improvement in mood and anxiety following deep brain stimulation was associated with reduced amygdala-insula functional connectivity. Directional connectivity analysis revealed that deep brain stimulation increased the impact of the ventromedial prefrontal cortex on the amygdala, and decreased the impact of the amygdala on the insula. These results highlight the importance of the amygdala circuit in the pathophysiology of obsessive-compulsive disorder, and suggest a neural systems model through which negative mood and anxiety are modulated by stimulation of the ventral anterior limb of the internal capsule for obsessive-compulsive disorder and possibly other psychiatric disorders. © The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain.OBJECTIVE The aim of this study was to determine the sustainability of hospital quality improvement teams and to assess factors influencing their sustainability in the regional referral hospital in Tanzania. DESIGN A cross-sectional study was conducted between April and August of 2018. SETTING AND PARTICIPANTS The study was conducted in four selected regional referral hospitals in Tanzania. All members of the quality improvement teams available during the study period were recruited. INTERVENTION Quality improvement teams and their activities. MAIN OUTCOME MEASURE The primary outcome was sustainability total scores. The secondary outcomes were process, staff and organizational sustainability scores. The sustainability of quality improvement teams was assessed by using the National Health Service Institute for Innovation and Improvement Sustainability Model self-assessment tool. RESULTS The overall mean sustainability score was 59.08 (95% CI 53.69-64.46). Tanga Regional Referral Hospital had the highest mean sustainability score of 66.15 (95% CI 55.12-77.18). Mbeya Regional Referral Hospital obtained the lowest mean sustainability score of 52.49 (95% CI 42.96-62.01). The process domain had the highest proportionate mean sustainability score of 22.46 (95% CI 20.58-24.33) across four hospitals. The staff domain recorded the lowest proportionate sustainability score of 27.28 (95% CI 24.76-29.80). CONCLUSIONS Perceived less involvement of senior leadership (hospital management teams) and clinical leadership (heads of clinical departments) and infrastructure limitation appeared to negatively affect the sustainability of the hospital quality improvement teams. Our study underscores the importance of establishing a permanent and fully resourced Quality Improvement Unit-with team members employed as full-time staff. © The Author(s) 2020. Published by Oxford University Press in association with the International Society for Quality in Health Care.BACKGROUND In countries with out-of-pocket (OOP) payment systems for healthcare, the combination of chronic disease and poverty can have damaging socio-economic and health impacts for affected households. Using a life course perspective, this article aims to explore how Nepalese people struggle with, experience and adapt to chronic disease, poverty and their consequences, and how chronic diseases and poverty reinforce each other. METHODS In-depth semi-structured interviews were conducted with 21 chronically ill Nepalese people with one or more chronic diseases and/or their caretakers. Data were transcribed and analysed thematically. RESULTS The adaptation strategies for the consequences of the huge OOP costs make patients and their households financially disadvantaged. The impoverishment has major social impacts and often persists across generations. The situation forces people to choose between avoiding medical treatment or further impoverishing their families. CONCLUSIONS This study explored how chronically ill Nepalese people struggle with socio-economic and health consequences of OOP payments for their disease. The article sheds light on circumstances and adaptation strategies that obstruct every attempt to escape from the vicious cycle of the poverty trap. Hence poverty and health adversities accumulate across generations and contribute to greater health expenditures, worse health outcomes and severely compromised social life. © The Author(s) 2020. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.Since 1997, the Resource Centers for Minority Aging Research Program at the National Institute on Aging has been the model for training social and behavioral scientists in minority aging and health disparities research. The latest cycle of these Centers implemented a new structure for the analytic training of junior investigators and for advancing methodologic work relevant to improving the rigor of minority aging research. In this article, we describe the conceptual framework, logistical approaches, challenges, and lessons learned from our experience training junior investigators in methodology through the Michigan Center for Urban African American Aging Research over the past 20 years, with the goal of informing future analytic training efforts for the next generation of scholars focused on minority aging issues. © The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.Iron deficiency anemia (IDA) is the most common nutrient-dependent health problem in the world and could be reversed by commercially available iron supplementation. The form of iron supplement is important due to its toxicity on the gastrointestinal system (GI), so the development of new dietary strategies might be important for the prevention of IDA. It has been shown that plant-based proteins bind to iron and might decrease the free form of iron before absorption and increase iron bioavailability. Thus, we aimed to form lentil derived protein-iron complexes and to test the functional properties of hydrolysed protein-iron complexes in anemic Caco-2 cell line. Our main findings were that (i) lentil derived proteins had the capacity to chelate iron minerals and (ii) hydrolysed protein-iron complexes significantly reduced the mRNA levels of iron regulated divalent metal transporter-1 (DMT1), transferrin receptor (TFR), and ankyrin repeat domain 37 (ANKRD37) marker genes that were induced by iron deficiency anemia. The current findings suggest that hydrolysed protein-iron complexes might have functional properties in iron deficiency anemia in vitro. Further in vivo studies are necessary to show lentil derived proteins and iron might be used as supplements or food additives to reduce the risk of iron deficiency anemia.We present a curious effect observed during the dissolution process of water-immersed long-chain alcohol drops with an entrapped air bubble. These droplets dissolve while entrapping an air bubble pinned at the substrate. We qualitatively describe and explain four different phases that are found during the dissolution of this kind of system. The dissolution rate in the four phases differ dramatically. When the drop-water interface and the air bubble contact each other, rapid cyclic changes of the morphology are found The breakage of the thin alcohol layer in between the bubble and the water leads to the formation of a three phase contact line. If the surface tension of the water-air interface supersedes those of the alcohol-water and alcohol-air interfaces, alcohol from the droplet is pulled upwards, leading to a closure of the air-water interface and the formation of a new thin alcohol film, which then dissolves again, leading to a repetition of the series of events. We call this sequence of events Marangoni puffing. This only happen for alcohols of appropriate surface tension. The Marangoni puffing is an intermediate state. In the final dissolution phases the Marangoni forces dramatically accelerate the dissolution rate, which then becomes one order of magnitude faster than the purely buoyancy-convective driven dissolution. Our results have bearing on various dissolution processes in multicomponent droplet systems.We investigated the hygroscopic growth of sodium chloride (NaCl) nanoparticles with curvature related diameters ranging from 10 nm to 200 nm, at different relative humidities using scanning force microscopy. Hygroscopic aerosol nanoparticles play a vital role in the Earth's climate and human health. We report that 10 nm NaCl nanoparticles adsorbed on silicon surfaces have a higher deliquescence relative humidity than larger NaCl nanoparticles (size > 30 nm). This finding is consistent with the observations for airborne nanoparticles by hygroscopicity tandem differential mobility analyzer. Therefore, the presence of silicon surfaces plays no significant role in the deliquescence relative humidity. Moreover, the study of individual airborne particles by means of scanning force microscopy revealed that the ability of water uptake, i.e. growth factor, of NaCl particles differs by as large as 40% at the same relative humidity. This finding indicates that the individual nature of NaCl particles influences the growth factor.Conductivity doping of organic semiconductors is an essential prerequisite for many organic devices, but the specifics of dopant activation are still not well understood. Using many-body simulations that include Coulomb interactions and dopant ionization/de-ionization events explicitly we here show significant doping efficiency even before the electron affinity of the dopant exceeds the ionization potential of the organic matrix (p-doping), similar to organic salts. We explicitly demonstrate that the ionization of weak molecular dopants in organic semiconductors is a disorder-, rather than thermally induced process. Practical implications of this finding are a weak dependence of the ionized dopant fraction on the electron affinity of the dopant, and an enhanced ionization of the weak dopants upon increasing dopant molar fraction. As a result, strategies towards dopant optimization should aim for presently neglected goals, such as the binding energy in host-dopant charge-transfer states being responsible for the number of mobile charge carriers.