Impact of provider attire on patient satisfaction in an outpatient dermatology clinic.

Provider attire has been studied as a potential vector for infectious microorganisms in the medical setting as well as a potential factor in patient satisfaction. Our objective was to determine if a change from formal attire to fitted scrubs had a measurable impact on patient satisfaction scores in an outpatient dermatology setting. We designed a 2-year retrospective cohort study of 22 providers in an outpatient dermatology setting who transitioned from formal attire to fitted scrubs and had at least 12 months of patient satisfaction scores (measured by a third-party patient satisfaction survey) before and after the change in attire. The primary outcome was statistically significant change in patient satisfaction scores before and after the institution of fitted scrubs. A total of 3511 completed surveys were evaluated from the 12 months prior to the change in attire (study period 1), and 4191 completed surveys were evaluated in 12 months after the change (study period 2). No significant change was seen in the overall survey responses. A small but statistically significant improvement was noted for several questions in study period 2, which suggested that a change from formal attire to fitted scrubs did not have a strong impact on patient satisfaction scores. Factors beyond provider attire likely have the greatest impact on patient satisfaction.

A new method for post-translationally labeling proteins in live cells for fluorescence imaging and tracking.

We present a novel method to fluorescently label proteins, post-translationally, within live Saccharomycescerevisiae. The premise underlying this work is that fluorescent protein (FP) tags are less disruptive to normal processing and function when they are attached post-translationally, because target proteins are allowed to fold properly and reach their final subcellular location before being labeled. We accomplish this post-translational labeling by expressing the target protein fused to a short peptide tag (SpyTag), which is then covalently labeled in situ by controlled expression of an open isopeptide domain (SpyoIPD, a more stable derivative of the SpyCatcher protein) fused to an FP. The formation of a covalent bond between SpyTag and SpyoIPD attaches the FP to the target protein. We demonstrate the general applicability of this strategy by labeling several yeast proteins. Importantly, we show that labeling the membrane protein Pma1 in this manner avoids the mislocalization and growth impairment that occur when Pma1 is genetically fused to an FP. We also demonstrate that this strategy enables a novel approach to spatiotemporal tracking in single cells and we develop a Bayesian analysis to determine the protein's turnover time from such data.

Myocardial deformation in fetuses with coarctation of the aorta: a case-control study.

OBJECTIVE: To study myocardial deformation by speckle tracking echocardiography in fetuses with coarctation of the aorta (CoA) compared with gestational age-matched normal controls. METHODS: This was a retrospective study of 12 fetuses with postnatally confirmed CoA and 12 gestational age-matched controls seen at a tertiary fetal cardiology unit between January 2013 and July 2014. Two-dimensional speckle tracking in standard grayscale four-chamber view of the fetal heart was performed to assess left and right myocardial deformation. Global longitudinal strain, strain rate and velocities, and regional longitudinal strain were analyzed and compared with controls. RESULTS: Median gestational age at echocardiography was 25 + 4 weeks. Fetuses with CoA presented with a narrower, but not shorter, left ventricle when compared with controls (mitral valve diastolic diameter, 5.90 vs 8.50 mm; P = 0.002; left ventricular diastolic length, 16.50 vs 18.50 mm; P = 0.05). Global longitudinal systolic strain (P = 0.004), systolic strain rate (P = 0.01) and diastolic strain rate (P = 0.004) of the left ventricle were significantly lower in fetuses with CoA compared with controls. Similar findings were observed for longitudinal systolic (P = 0.03) and diastolic (P = 0.01) velocities of the left ventricle. Right ventricular parameters were not different between groups. CONCLUSIONS: Fetuses with CoA have lower left ventricular longitudinal systolic strain, systolic strain rate and diastolic strain rate when compared with gestational age-matched control fetuses. These differences in deformation might explain, at least in part, the cardiac asymmetry observed in fetuses with CoA. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Efficient, designable, and broad-bandwidth optical extinction via aspect-ratio-tailored silver nanodisks.

Subwavelength resonators, ranging from single atoms to metallic nanoparticles, typically exhibit a narrow-bandwidth response to optical excitations. We computationally design and experimentally synthesize tailored distributions of silver nanodisks to extinguish light over broad and varied frequency windows. We show that metallic nanodisks are 2-10x more efficient in absorbing and scattering light than common structures, and can approach fundamental limits to broadband scattering for subwavelength particles. We measure broadband extinction per volume that closely approaches theoretical predictions over three representative visible-range wavelength windows, confirming the high efficiency of nanodisks and demonstrating the collective power of computational design and experimental precision for developing new photonics technologies.

What's new: Management of venous leg ulcers: Approach to venous leg ulcers.

Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing.

What's new: Management of venous leg ulcers: Treating venous leg ulcers.

Venous leg ulcers account for approximately 70% of all leg ulcers and affect 2.2 million Americans annually. After a comprehensive patient and wound assessment, compression therapy remains the cornerstone of standard care. Adjuvant care with topical or systemic agents is used for wounds that do not heal within 4 weeks. Once healed, long-term compression therapy with stockings or surgical intervention will reduce the incidence of recurrence. This continuing medical education article aims to outline optimal management for patients with venous leg ulcers, highlighting the role of a multidisciplinary team in delivering high quality care.

Prenatal diagnosis of left ventricular diverticulum and coarctation of the aorta.

Congenital left ventricular diverticulum (LVD) is a rare abnormality of the myocardium which has been detected previously in the fetus. Lesions have been reported from as early as 12 weeks' gestation but are more commonly detected in the mid-second trimester. Fetal presentation of LVD ranges from an abnormal four-chamber view of the heart, arrhythmia or isolated pericardial effusion to fetal hydrops with associated heart failure. Here, we describe the prenatal diagnosis of an infant with LVD originating from the left ventricular outflow tract associated with coarctation of the aorta. The diagnosis was confirmed postnatally by two-dimensional echocardiography and cardiac magnetic resonance imaging. We hypothesize that the lesion compromised antegrade flow into the transverse aortic arch, which may have contributed to underdevelopment of the aortic arch and subsequently the development of coarctation of the aorta. This is a unique case of LVD and coarctation of the aorta.

Fundamental limits to extinction by metallic nanoparticles.

We show that there are shape-independent upper bounds to the extinction cross section per unit volume of dilute, randomly arranged nanoparticles, given only material permittivity. Underlying the limits are restrictive sum rules that constrain the distribution of quasistatic eigenvalues. Surprisingly, optimally designed spheroids, with only a single quasistatic degree of freedom, reach the upper bounds for four permittivity values. Away from these permittivities, we demonstrate computationally optimized structures that surpass spheroids and approach the fundamental limits.

Near-field electromagnetic theory for thin solar cells.

Current methods for evaluating solar cell efficiencies cannot be applied to low-dimensional structures where phenomena from the realm of near-field optics prevail. We present a theoretical approach to analyze solar cell performance by allowing rigorous electromagnetic calculations of the emission rate using the fluctuation-dissipation theorem. Our approach shows the direct quantification of the voltage, current, and efficiency of low-dimensional solar cells. This approach is demonstrated by calculating the voltage and the efficiency of a GaAs slab solar cell for thicknesses from several microns down to a few nanometers. This example highlights the ability of the proposed approach to capture the role of optical near-field effects in solar cell performance.

Phylogenetic analysis of spring virema of carp virus reveals distinct subgroups with common origins for recent isolates in North America and the UK.

Genetic relationships between 35 spring viremia of carp virus (SVCV) genogroup Ia isolates were determined based on the nucleotide sequences of the phosphoprotein (P) gene and glycoprotein (G) genes. Phylogenetic analysis based on P gene sequences revealed 2 distinct subgroups within SVCV genogroup Ia, designated SVCV Iai and Iaii, and suggests at least 2 independent introductions of the virus into the USA in 2002. Combined P- and G-sequence data support the emergence of SVCV in Illinois, USA, and in Lake Ontario, Canada, from the initial outbreak in Wisconsin, USA, and demonstrate a close genetic link to viruses isolated during routine import checks on fish brought into the UK from Asia. The data also showed a genetic link between SVCV isolations made in Missouri and Washington, USA, in 2004 and the earlier isolation made in North Carolina, USA, in 2002. However, based on the close relationship to a 2004 UK isolate, the data suggest than the Washington isolate represents a third introduction into the US from a common source, rather than a reemergence from the 2002 isolate. There was strong phylogenetic support for an Asian origin for 9 of 16 UK viruses isolated either from imported fish, or shown to have been in direct contact with fish imported from Asia. In one case, there was 100% nucleotide identity in the G-gene with a virus isolated in China.

Effect of in vivo hypoxic preconditioning on changes in intracellular calcium content induced by long-term anoxia in rat brain slices.

We studied changes in intracellular calcium content induced by 10-min anoxia in olfactory cortex slices from rats exposed to single or 3-fold moderate hypobaric hypoxia ("ascend" at 5000 m). Repeated preconditioning with moderate hypobaric hypoxia produced a neuroprotective effect. This treatment abolished pathological calcium overload in brain slices induced in vitro by 10-min test anoxia.