Feasibility study for the development of multilayered solar cells for proton linear energy transfer depth profile measurement.

BACKGROUND: Previous study proposed a method to measure linear energy transfer (LET) at specific points using the quenching magnitude of thin film solar cells. This study was conducted to propose a more advanced method for measuring the LET distribution. PURPOSE: This study focuses on evaluating the feasibility of estimating the proton LET distribution in proton therapy. The feasibility of measuring the proton LET and dose distribution simultaneously using a single-channel configuration comprising two solar cells with distinct quenching constants is investigated with the objective of paving the way for enhanced proton therapy dosimetry. METHODS: Two solar cells with different quenching constants were used to estimate the proton LET distribution. Detector characteristics (e.g., dose linearity and dose-rate dependency) of the solar cells were evaluated to assess their suitability for dosimetry applications. First, using a reference beam condition, the quenching constants of the two solar cells were determined according to the modified Birks equation. The signal ratios of the two solar cells were then evaluated according to proton LET in relation to the estimated quenching constants. The proton LET distributions of six test beams were obtained by measuring the signal ratios of the two solar cells at each depth, and the ratios were evaluated by comparing them with those calculated by Monte Carlo simulation. RESULTS: The detector characterization of the two solar cells including dose linearity and dose-rate dependence affirmed their suitability for use in dosimetry applications. The maximum difference between the LET measured using the two solar cells and that calculated by Monte Carlo simulation was 2.34 keV/µm. In the case of the dose distribution measured using the method proposed in this study, the maximum difference between range measured using the proposed method and that measured using a multilayered ionization chamber was 0.7 mm. The expected accuracy of simultaneous LET and dose distribution measurement using the method proposed in this study were estimated to be 3.82%. The signal ratios of the two solar cells, which are related to quenching constants, demonstrated the feasibility of measuring LET and dose distribution simultaneously. CONCLUSION: The feasibility of measuring proton LET and dose distribution simultaneously using two solar cells with different quenching constants was demonstrated. Although the method proposed in this study was evaluated using a single channel by varying the measuring depth, the results suggest that the proton LET and dose distribution can be simultaneously measured if the detector is configured in a multichannel form. We believe that the results presented in this study provide the envisioned transition to a multichannel configuration, with the promise of substantially advancing proton therapy's accuracy and efficacy in cancer treatment.

Patient characteristics and telehealth are associated with attendance rates in an outpatient rehabilitation infant bridge program.

OBJECTIVE: To describe the characteristics of patients who received outpatient therapy services through an infant bridge program using telehealth mode of service delivery and to identify if attendance rates vary by mode of service delivery. We hypothesized that telehealth visits will increase attendance rates. DESIGN: Retrospective, cross-sectional study. SETTING: UCSF Benioff Children's Hospital outpatient infant bridge program. PARTICIPANTS: Eighty infants with a history of NICU admission and scheduled for a therapy appointment between June 1, 2019 and December 31, 2020 were included in the study. Participants had an average(SD) gestational age of 34.63(4.41) weeks and length of stay was 43.55(56.03) weeks. The majority were English-speaking (96.3%), White (37.5%), and had commercial insurance (72.5%). MAIN OUTCOME MEASURE: Descriptive analyses were conducted across the entire group along with service delivery model subgroup analysis. Logistic regression was performed to assess patient characteristics associated with attendance and if service delivery model influences attendance. RESULTS: In the analysis of 596 scheduled visits, there were more completed telehealth sessions than for in-person sessions (90.0% versus 84.1%, p = .011). For in-person sessions, infants (N = 40) with lower birth gestational ages (p = .009), longer length of stay (p = .041), and Medi-Cal insurance (p = .006) were more likely to have ≥2 missed appointments. For the telehealth sessions, infants (N = 40) who had longer length of stay (p = .040) were more likely to have ≥2 missed appointments. There is a higher likelihood of ≥2 missed appointments for patients with a longer length of stay (OR = 1.02, 95% CI [1.01, 1.03]) and for in-person service delivery when compared to telehealth (OR = 6.25, 95% CI [1.37, 28.57]). CONCLUSIONS: Telehealth was associated with higher likelihood of attendance, revealing that telehealth has the potential to increase access to early therapy services for certain populations. Future studies with larger sample sizes to determine which populations benefit from telehealth is recommended.

Examining rehabilitation access disparities: an integrated analysis of electronic health record data and population characteristics through bivariate choropleth mapping.

BACKGROUND: Despite efforts to view electronic health records (EHR) data through an equity lens, crucial contextual information regarding patients' social environments remains limited. Integrating EHR data and Geographic Information Systems (GIS) technology can give deeper insights into the relationships between patients' social environments, health outcomes, and geographic factors. This study aims to identify regions with the fastest and slowest access to outpatient physical therapy services using bivariate choropleth maps to provide contextual insights that may contribute to health disparity in access. METHODS: This was a retrospective cohort study of patients' access timelines for the first visit to outpatient physical therapy services (n = 10,363). The three timelines evaluated were (1) referral-to-scheduled appointment time, (2) scheduled appointment to first visit time, and (3) referral to first visit time. Hot and coldspot analyses (CI 95%) determined the fastest and slowest access times with patient-level characteristics and bivariate choropleth maps that were developed to visualize associations between access patterns and disadvantaged areas using Area Deprivation Index scores. Data were collected between January 1, 2016 and January 1, 2020. EHR data were geocoded via GIS technology to calculate geospatial statistics (Gi∗ statistic from ArcGIS Pro) in an urban area. RESULTS: Statistically significant differences were found for all three access timelines between coldspot (i.e., fast access group) and hotspot (i.e., slow access group) comparisons (p < .05). The hotspot regions had higher deprivation scores; higher proportions of residents who were older, privately insured, female, lived further from clinics; and a higher proportion of Black patients with orthopaedic diagnoses compared to the coldspot regions. CONCLUSIONS: Our study identified and described local areas with higher densities of patients that experienced longer access times to outpatient physical therapy services. Integration of EHR and GIS data is a more robust method to identify health disparities in access to care. With this approach, we can better understand the intricate interplay between social, economic, and environmental factors contributing to health disparities in access to care.

Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial.

BACKGROUND: Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. OBJECTIVE: The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. METHODS: We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. RESULTS: A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (-1.8, 95% CI -13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. CONCLUSIONS: This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528.

Automatic extraction of social determinants of health from medical notes of chronic lower back pain patients.

OBJECTIVE: We applied natural language processing and inference methods to extract social determinants of health (SDoH) information from clinical notes of patients with chronic low back pain (cLBP) to enhance future analyses of the associations between SDoH disparities and cLBP outcomes. MATERIALS AND METHODS: Clinical notes for patients with cLBP were annotated for 7 SDoH domains, as well as depression, anxiety, and pain scores, resulting in 626 notes with at least one annotated entity for 364 patients. We used a 2-tier taxonomy with these 10 first-level classes (domains) and 52 second-level classes. We developed and validated named entity recognition (NER) systems based on both rule-based and machine learning approaches and validated an entailment model. RESULTS: Annotators achieved a high interrater agreement (Cohen's kappa of 95.3% at document level). A rule-based system (cTAKES), RoBERTa NER, and a hybrid model (combining rules and logistic regression) achieved performance of F1 = 47.1%, 84.4%, and 80.3%, respectively, for first-level classes. DISCUSSION: While the hybrid model had a lower F1 performance, it matched or outperformed RoBERTa NER model in terms of recall and had lower computational requirements. Applying an untuned RoBERTa entailment model, we detected many challenging wordings missed by NER systems. Still, the entailment model may be sensitive to hypothesis wording. CONCLUSION: This study developed a corpus of annotated clinical notes covering a broad spectrum of SDoH classes. This corpus provides a basis for training machine learning models and serves as a benchmark for predictive models for NER for SDoH and knowledge extraction from clinical texts.

Determination of the proton LET using thin film solar cells coated with scintillating powder.

PURPOSE: The amount of luminescent light detected in a scintillator is reduced with increased proton linear energy transfer (LET) despite receiving the same proton dose, through a phenomenon called quenching. This study evaluated the ability of a solar cell coated with scintillating powder (SC-SP) to measure therapeutic proton LET by measuring the quenching effect of the scintillating powder using a solar cell while simultaneously measuring the dose of the proton beam. METHODS: SC-SP was composed of a flexible thin film solar cell and scintillating powder. The LET and dose of the pristine Bragg peak in the 14 cm range were calculated using a validated Monte Carlo model of a double scattering proton beam nozzle. The SC-SP was evaluated by measuring the proton beam under the same conditions at specific depths using SC-SP and Markus chamber. Finally, the 10 and 20 cm range pristine Bragg peaks and 5 cm spread-out Bragg peak (SOBP) in the 14 cm range were measured using the SC-SP and the Markus chamber. LETs measured using the SC-SP were compared with those calculated using Monte Carlo simulations. RESULTS: The quenching factors of the SC-SP and solar cell alone, which were slopes of linear fit obtained from quenching correction factors according to LET, were 0.027 and 0.070 µm/keV (R2 : 0.974 and 0.975). For pristine Bragg peaks in the 10 and 20 cm ranges, the maximum differences between LETs measured using the SC-SP and calculated using Monte Carlo simulations were 0.5 keV/µm (15.7%) and 1.2 keV/µm (12.0%), respectively. For a 5 cm SOBP proton beam, the LET measured using the SC-SP and calculated using Monte Carlo simulations differed by up to 1.9 keV/µm (18.7%). CONCLUSIONS: Comparisons of LETs for pristine Bragg peaks and SOBP between measured using the SC-SP and calculated using Monte Carlo simulations indicated that the solar cell-based system could simultaneously measure both LET and dose in real-time and is cost-effective.

Development of a real-time in vivo dosimetry tool for electron beam therapy using a flexible thin film solar cell coated with scintillator powder.

PURPOSE: A real-time solar cell based in vivo dosimetry system (SC-IVD) was developed using a flexible thin film solar cell and scintillating powder. The present study evaluated the clinical feasibility of the SC-IVD in electron beam therapy. METHODS: A thin film solar cell was coated with 100 mg of scintillating powder using an optical adhesive to enhance the sensitivity of the SC-IVD. Calibration factors were obtained by dividing the dose, measured at a reference depth for 6-20 MeV electron beam energy, by the signal obtained using the SC-IVD. Dosimetric characteristics of SC-IVDs containing variable quantities of scintillating powder (0-500 mg) were evaluated, including energy, dose rate, and beam angle dependencies, as well as dose linearity. To determine the extent to which the SC-IVD affected the dose to the medium, doses at R90 were compared depending on whether the SC-IVD was on the surface. Finally, the accuracy of surface doses measured using the SC-IVD was evaluated by comparison with surface doses measured using a Markus chamber. RESULTS: Charge measured using the SC-IVD increased linearly with dose and was within 1% of the average signal according to the dose rate. The signal generated by the SC-IVD increased as the beam angle increased. The presence of the SC-IVD on the surface of a phantom resulted in a 0.5%-2.2% reduction in dose at R90 for 6-20 MeV electron beams compared with the bare phantom. Surface doses measured using the SC-IVD system and Markus chamber differed by less than 5%. CONCLUSIONS: The dosimetric characteristics of the SC-IVD were evaluated in this study. The results showed that it accurately measured the surface dose without a significant difference of dose in the medium when compared with the Markus chamber. The flexibility of the SC-IVD allows it to be attached to a patient's skin, enabling real-time and cost-effective measurement.

Building a Foundation for Health Informatics Content in Physical Therapy Education Through Concept Analysis and Concept Mapping.

INTRODUCTION: Health informatics curricular content, while beneficial to the spectrum of education in physical therapy, is currently only required in physical therapist education programs, and even there, it is only crudely defined. The purpose of our study was to use the techniques of concept analysis and concept mapping to provide an outline of informatics content that can be the foundation for curriculum development and the construction of informatics competencies for physical therapy. REVIEW OF LITERATURE: There is no established consensus on the definition of health informatics. Medical and nursing informatics literature that clarifies and agrees on the attributes of health informatics is insufficient for curriculum development. Concept analysis is an approach commonly used in nursing and other health professions to analyze and deconstruct a term, in this case, health informatics, in order to provide clarity on its meaning. SUBJECTS: A total of 73 definitions of health informatics were extracted from articles that met search criteria. METHODS: We used an 8-step methodology from the literature for concept analysis, which included 1) selecting a concept; 2) determining the aims of the analysis; 3) identifying uses of the concept; 4) determining the defining attributes of the concept; 5) identifying a model case; 6) identifying related and illegitimate cases; 7) identifying antecedents and consequences; and 8) defining empirical referents. In addition, concept mapping was used to develop a visual representation of the thematic attributes and the elements that make them up. RESULTS: We provide a visual map of the concept we now term "informatics in human health and health care" and clarify its attributes of data, disciplinary lens, multidisciplinary science, technology, and application. We also provide clarification through the presentation of a model case and a contrary case. DISCUSSION AND CONCLUSION: Concept analysis and mapping of informatics in human health and health care provided clarity on content that should be addressed across the continuum of physical therapy education. The next steps from this work will be to develop competencies for all levels of physical therapy education.

Physical Therapist Telehealth Delivery at 1 Year Into COVID-19.

OBJECTIVE: The purpose of this study was to examine telehealth physical therapy utilization 1 year into the COVID-19 pandemic and identify factors that influence physical therapists' delivery of telehealth in an urban academic medical center. METHODS: Electronic medical record data were extracted within the dates of interest (March 22, 2021 to May 15, 2021), the proportion of physical therapy sessions delivered via telehealth were identified, and patient characteristics were compared by telehealth volume (0 vs ≥1 session, 1 vs >1 session). Qualitative data also were collected from physical therapists via semi-structured interviews, and a directed content analysis was conducted, informed by the Capability, Opportunity, Motivation, and Behavior model, to identify factors influencing telehealth delivery. RESULTS: Telehealth was used for 3793 of 8038 (47.2%) physical therapist sessions, and 1028 unique patients had at least 2 physical therapist sessions (without telehealth: 6.6% [n = 68], telehealth once: 39.1% [n = 402], telehealth more than once: 54.3% [n = 558]). Patients without telehealth were older, non-English speaking, had non-commercial insurance, and had at least 1 chronic health condition. Patients with telehealth more than once had a neurologic diagnosis and lived farther from the treating clinic. Capabilities that influenced telehealth delivery were physical therapist clinical skills and knowledge, technical proficiency, telehealth-specific interpersonal skills, and cognitive flexibility. Factors external to physical therapists-including the environment, patient equipment and technology proficiency, physical therapist equipment, clinic factors, and patient and referring provider perspectives-also influenced telehealth delivery. Finally, patient needs and telehealth as a beneficial tool guided physical therapist intention to use telehealth. CONCLUSION: Sustained telehealth utilization outcomes 1 year into the COVID-19 pandemic and an interaction among physical therapist, patient, and environmental factors support the long-term potential of telehealth physical therapy in an urban academic medical center. IMPACT: These findings support the long-term potential of telehealth approaches and can be used to inform telehealth physical therapist training programs and clinical implementation, future research, and health policy.

Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study.

BACKGROUND: Although evidence-based guidelines for physical therapy for patients with chronic low back pain (cLBP) are available, selecting patient-reported outcome measures to capture complexity of health status and quality of life remains a challenge. PROMIS-10 Global Health (GH) may be used to screen for impactful health risks and enable patient-centered care. The purpose of this study was to investigate the interrelationships between PROMIS-10 GH scores and patient demographics, health status, and healthcare utilization in patients with cLBP who received physical therapy. METHODS: A retrospective review of de-identified electronic health records of patients with cLBP was performed. Data were collected for 328 patients seen from 2017 to 2020 in three physical therapy clinics. Patients were grouped into HIGH and LOW initial assessment scores on the PROMIS-10 Global Physical Health (PH) and Global Mental Health (MH) measures. Outcomes of interest were patient demographics, health status, and healthcare utilization. Mann-Whitney U and chi-square tests were used to determine differences between groups, and binary logistic regression was used to calculate odds ratios (OR) to determine predictors of PH-LOW and MH-LOW group assignments. RESULTS: The PH-LOW and MH-LOW groups contained larger proportions of patients who were African American, non-Hispanic, and non-commercially insured compared to PH-HIGH and MH-HIGH groups (p < .05). The PH-LOW and MH-LOW groups also had a higher Charlson comorbidity index (CCI), higher rates of diabetes and depression, and more appointment cancellations or no-shows (p < .05). African American race (OR 2.54), other race (2.01), having Medi-Cal insurance (OR 3.37), and higher CCI scores (OR 1.55) increased the likelihood of being in the PH-LOW group. African American race (OR 3.54), having Medi-Cal insurance (OR 2.19), depression (OR 3.15), kidney disease (OR 2.66), and chronic obstructive pulmonary disease (OR 1.92) all increased the likeihood of being in the MH-LOW group. CONCLUSIONS: Our study identified groups of patients with cLBP who are more likely to have lower PH and MH scores. PROMIS-10 GH provides an opportunity to capture and identify quality of life and global health risks in patients with cLBP. Using PROMIS-10 in physical therapy practice could help identify psychosocial factors and quality of life in the population with cLBP.

Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic.

OBJECTIVE: The objective was to evaluate implementation of telehealth physical therapy in response to COVID-19 and identify implementation strategies to maintain and scale up telehealth physical therapy within a large urban academic medical center. METHODS: The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework was used to evaluate telehealth physical therapy implementation. Patient-level data were extracted from electronic medical records between March 16, 2020, and May 16, 2020 (implementation phase). Reach was defined as the proportion of physical therapy sessions completed via telehealth. Effectiveness was assessed using a patient-reported satisfaction survey with a 5-point Likert scale. Adoption was defined as the proportion of physical therapists who used telehealth. Implementation was assessed through qualitative analysis of patient and clinician perspectives to identify emergent themes, retrospectively classify strategies used during the implementation phase, and prospectively identify evidence-based strategies to increase telehealth maintenance and scale-up. Maintenance of telehealth was defined as the proportion of patients who indicated they would attend another telehealth session. RESULTS: There were 4548 physical therapy sessions provided by 40 therapists from March 22, 2020, to May 16, 2020, of which 3883 (85%) were telehealth. Ninety-four percent of patients were satisfied. All physical therapists (100%) used telehealth technology at least once. Retrospectively classified and prospectively identified evidence-based strategies were organized into 5 qualitative themes that supported implementation: organizational factors (policies, preexisting partnerships), engaging external stakeholders (satisfaction survey), champions (clinician leaders), clinician education (dynamic, ongoing training), and process (promote adaptability, small tests of change). Ninety-two percent of patients reported they would attend another telehealth session. CONCLUSION: Findings from this study suggest that implementation of telehealth physical therapy during the COVID-19 pandemic was feasible and acceptable in this setting. IMPACT: These results can be used to guide future health policy, quality improvement, and implementation science initiatives to expand the use and study of telehealth for physical therapy.

Mutations in SPATA13/ASEF2 cause primary angle closure glaucoma.

Current estimates suggest 50% of glaucoma blindness worldwide is caused by primary angle-closure glaucoma (PACG) but the causative gene is not known. We used genetic linkage and whole genome sequencing to identify Spermatogenesis Associated Protein 13, SPATA13 (NM_001166271; NP_001159743, SPATA13 isoform I), also known as ASEF2 (Adenomatous polyposis coli-stimulated guanine nucleotide exchange factor 2), as the causal gene for PACG in a large seven-generation white British family showing variable expression and incomplete penetrance. The 9 bp deletion, c.1432_1440del; p.478_480del was present in all affected individuals with angle-closure disease. We show ubiquitous expression of this transcript in cell lines derived from human tissues and in iris, retina, retinal pigment and ciliary epithelia, cornea and lens. We also identified eight additional mutations in SPATA13 in a cohort of 189 unrelated PACS/PAC/PACG samples. This gene encodes a 1277 residue protein which localises to the nucleus with partial co-localisation with nuclear speckles. In cells undergoing mitosis SPATA13 isoform I becomes part of the kinetochore complex co-localising with two kinetochore markers, polo like kinase 1 (PLK-1) and centrosome-associated protein E (CENP-E). The 9 bp deletion reported in this study increases the RAC1-dependent guanine nucleotide exchange factors (GEF) activity. The increase in GEF activity was also observed in three other variants identified in this study. Taken together, our data suggest that SPATA13 is involved in the regulation of mitosis and the mutations dysregulate GEF activity affecting homeostasis in tissues where it is highly expressed, influencing PACG pathogenesis.

Locally Gated SnS2/hBN Thin Film Transistors with a Broadband Photoresponse.

Next-generation flexible and transparent electronics demand newer materials with superior characteristics. Tin dichalcogenides, Sn(S,Se)2, are layered crystal materials that show promise for implementation in flexible electronics and optoelectronics. They have band gap energies that are dependent on their atomic layer number and selenium content. A variety of studies has focused in particular on tin disulfide (SnS2) channel transistors with conventional silicon substrates. However, the effort of interchanging the gate dielectric by utilizing high-quality hexagonal boron nitride (hBN) still remains. In this work, the hBN coupled SnS2 thin film transistors are demonstrated with bottom-gated device configuration. The electrical transport characteristics of the SnS2 channel transistor present a high current on/off ratio, reaching as high as 105 and a ten-fold enhancement in subthreshold swing compared to a high-κ dielectric covered device. We also demonstrate the spectral photoresponsivity from ultraviolet to infrared in a multi-layered SnS2 phototransistor. The device architecture is suitable to promote diverse studied on flexible and transparent thin film transistors for further applications.

Enhancement of near-infrared detectability from InGaZnO thin film transistor with MoS2 light absorbing layer.

We report an enhancement of near-infrared (NIR) detectability from amorphous InGaZnO (α-IGZO) thin film transistor in conjunction with randomly distributed molybdenum disulfide (MoS2) flakes. The electrical characteristics of the α-IGZO grown by radio-frequency magnetron sputtering exhibit high effective mobility exceeding 15 cm2 V-1 s-1 and current on/off ratio up to 107. By taking advantages of the high quality α-IGZO and MoS2 light absorbing layer, photodetection spectra are able to extend from ultra-violet to NIR range. The α-IGZO channel detector capped by MoS2 show a photo-responsivity of approximately 14.9 mA W-1 at 1100 nm wavelength, which is five times higher than of the α-IGZO device without MoS2 layer.

Triple negative invasive lobular carcinoma of the breast presents as small bowel obstruction.

Metastasis from breast carcinoma to the gastrointestinal tract (GIT) is very uncommon. To date, only a few cases have been described worldwide. Of those which do metastasize to the GIT, only estrogen receptor (ER), progesterone receptor (PR) and HER2-neu receptor positive cancers have been reported and none have been mentioned in the U.S. We report a case of a 70-year-old white female with history of triple negative lobular carcinoma eight years earlier who presented with solitary jejunal mass causing obstruction.

Electrical and photovoltaic properties of residue-free MoS2 thin films by liquid exfoliation method.

Molybdenum disulfide (MoS2) film fabricated by a liquid exfoliation method has significant potential for various applications, because of its advantages of mass production and low-temperature processes. In this study, residue-free MoS2 thin films were formed during the liquid exfoliation process and their electrical properties were characterized with an interdigitated electrode. Then, the MoS2 film thickness could be controlled by centrifuge condition in the range of 20 âˆ¼ 40 nm, and its carrier concentration and mobility were measured at about 7.36 × 1016 cm-3 and 4.67 cm2 V-1 s-1, respectively. Detailed analysis on the films was done by atomic force microscopy, Raman spectroscopy, and high-resolution transmission electron microscopy measurements for verifying the film quality. For application of the photovoltaic device, a Au/MoS2/silicon/In junction structure was fabricated, which then showed power conversion efficiency of 1.01% under illumination of 100 mW cm-2.

Linearly and Highly Pressure-Sensitive Electronic Skin Based on a Bioinspired Hierarchical Structural Array.

Pressure-sensitive electronic skin composed of a hierarchical structural array exhibits outstanding linear and high sensitivity in the pressure range exerted by gentle touch. By virtue of monolayer graphene acting as electrode material, this device can be operated with low voltage. Especially, its high transparency enables an accurate placement of the device on the target position when it is used for health monitoring.

Mercury accumulation in hydrothermal vent mollusks from the southern Tonga Arc, southwestern Pacific Ocean.

We provide the mercury (Hg) and monomethylmercury (MMHg) levels of the plume water, sulfide ore, sediment, and mollusks located at the hydrothermal vent fields of the southern Tonga Arc, where active volcanism and intense seismic activity occur frequently. Our objectives were: (1) to address the potential release of Hg from hydrothermal fluids and (2) to examine the distribution of Hg and MMHg levels in hydrothermal mollusks (mussels and snails) harboring chemotrophic bacteria. While high concentrations of Hg in the sediment and Hg, As, and Sb in the sulfide ore indicates that their source is likely hydrothermal fluids, the MMHg concentration in the sediment was orders of magnitude lower than the Hg (<0.001%). It suggests that Hg methylation may have not been favorable in the vent field sediment. In addition, Hg concentrations in the mollusks were much higher (10-100 times) than in other hydrothermal vent environments, indicating that organisms located at the Tonga Arc are exposed to exceedingly high Hg levels. While Hg concentration was higher in the gills and digestive glands than in the mantles and residues of snails and mussels, the MMHg concentrations in the gills and digestive glands were orders of magnitude lower (0.004-0.04%) than Hg concentrations. In summary, our results suggest that the release of Hg from the hydrothermal vent fields of the Tonga Arc and subsequent bioaccumulation are substantial, but not for MMHg.

Mitochondrial genome of the hydrothermal vent shrimp Nautilocaris saintlaurentae (Crustacea: Caridea: Alvinocarididae).

We determined the mitochondrial genome (mitogenome) of Nautilocaris saintlaurentae, sampled at vent fields of the Tofua Arc in the southwestern Pacific. The genome was 15,928 bp in length and had the typical mitogenome structure of the infraorder Caridea. Its protein-coding genes were very similar to other alvinocaridid species in respect to length, AT content, and start and stop codons. However, N. saintlaurentae showed a 17.4--19.2% divergence in the nucleotide sequence from other alvinocaridid species. This information will be helpful in understanding the genetic relationship among members of the alvinocaridid shrimps.

Associations between narrow angle and adult anthropometry: the Liwan Eye Study.

PURPOSE: To assess the associations between narrow angle and adult anthropometry. METHODS: Chinese adults aged 50 years and older were recruited from a population-based survey in the Liwan District of Guangzhou, China. Narrow angle was defined as the posterior trabecular meshwork not visible under static gonioscopy in at least three quadrants (i.e. a circumference of at least 270°). Logistic regression models were used to examine the associations between narrow angle and anthropomorphic measures (height, weight and body mass index, BMI). RESULTS: Among the 912 participants, lower weight, shorter height, and lower BMI were significantly associated with narrower angle width (tests for trend: mean angle width in degrees vs weight p < 0.001; vs height p < 0.001; vs BMI p = 0.012). In univariate analyses, shorter height, lower weight and lower BMI were all significantly associated with greater odds of narrow angle. The crude association between height and narrow angle was largely attributable to a stronger association with age and sex. Lower BMI and weight remained significantly associated with narrow angle after adjustment for height, age, sex, axial ocular biometric measures and education. In analyses stratified by sex, the association between BMI and narrow angle was only observed in women. CONCLUSION: Lower BMI and weight were associated with significantly greater odds of narrow angle after adjusting for age, education, axial ocular biometric measures and height. The odds of narrow angle increased 7% per 1 unit decrease in BMI. This association was most evident in women.