Abstract Introduction Patients with head and neck cancer (HNC) experience unique physical and psychosocial challenges that impact their health and quality of life. Early implementation of palliative care has been shown to improve various health care outcomes. Objective The aim of the present study was to evaluate the patterns of referral of patients with HNC to outpatient palliative care as they relate to utilization of resources and end-of-life discussions. Methods We performed a retrospective review of 245 patients with HNC referred to outpatient palliative care services at two Louisiana tertiary care centers from June 1, 2014, to October 1, 2019. The control group consisted of those that were referred but did not follow-up. Reasons for referral were obtained, and outcome measures such as emergency department (ED) visits, hospital readmissions, and advance care planning (ACP) documentation were assessed according to predictive variables. Results There were 177 patients in the treatment group and 68 in the control group. Patients were more likely to follow up to outpatient palliative care services if referred for pain management. Hospital system, prior inpatient palliative care, and number of outpatient visits were associated with an increased likelihood for ED visits and hospital readmissions. Those in the palliative care treatment group were also more likely to have ACP discussions. Conclusion Early implementation of outpatient palliative care among patients with HNC can initiate ACP discussions. However, there are discrepancies in referral reasons to palliative care and continued existing barriers to its effective utilization.

ABSTRACT The present study was conducted to investigate the efficacy of oral administration of L. reuteri on growth performance, intestine histomorphology, immunological and gut microbiome of broilers. A total of twenty healthy chickens were used in a five-week experimental trial. Birds were assigned into one of two groups with orally administrated L. reuteri probiotic and without probiotic- (Control -Phosphate-buffered saline). A significant (p<0.05) body weight gain was observed in the chickens in L. reuteri treatment group compare to those in the control group at the end of the trial. In addition, the serum IGF-1 cytokines level significantly enhanced in L. reuteri treatment group. However, there were no notable effects observed on the villus height, crypt depth, muscularis thickness, and submucosal thickness in chickens orally inject with and without L. reuteri. At the phylum level, the presence of Firmicutes (99.5%) was highly abundantin the L. reuteri treatment group. Moreover, the fecal microbial communities of Lactobacillus (99.9%) showed average relative abundance at genus level in L. reuteri treatment group. From this, we concluded that oral administration of L. reuteri would be beneficial to enhance the body weight gain, gut microbiome, and immune status of broiler.

Abstract The aim of this study is to investigate the effect of a continuous stream of pulses of monochromatic blue pulsed (BP) and a combination of blue and green pulsed (BGP) light-emitting diode (LED) light conditions on physiological responses. This study is an approach to clarify the most suitable LED combination and flickering frequency to evoke alertness when a continuous stream of pulsed LED light is delivered and may suggest applications of continuous pulsed light as support for task illumination for shift workers, hospital nurses, school students or office employees. Combinations were delivered by exposures of BPLED and BGPLED pulses at 100, 200, and 400 Hertz over two background light colors (BLC). Participants were exposed to 12 different light conditions in a counterbalanced procedure. By integrating measures of electroencephalogram (EEG) and pupil constriction; results suggested significant changes in responses during the interaction of BLC, LED, and EEG. Beta waves exhibited a statistically significance (p < 0.05) in arousal levels when exposed to BG light, although no active task was involved during exposure. Furthermore, pupil reacted with larger constriction towards BGPLED exposure than towards monochromatic BPLED exposure, thus demonstrating that a continuous stream of pulses can deliver the same irradiance as if delivered in a continuous flow and without affecting perception as no flickering was perceived in any of the conditions by a qualitative evaluation.

Resumen Este estudio tiene por objetivo determinar cuál es la combinación de luz LED más adecuada y la frecuencia de parpadeo que esta deba tener, para evocar un estado de alerta cuando se emite un flujo continuo de la misma al combinarla con una iluminación de ambiente; y poder sugerir aplicaciones como soporte para la iluminación de tareas para trabajadores por turnos, enfermeras, médicos, estudiantes; o en oficinas y hospitales. Es de original importancia resaltar que en el mercado no existe un producto comercial que se pueda ajustar para apoyar en el trabajo al estado de alerta, se tiene la limitante que estas son pruebas a nivel laboratorio y que posteriores pruebas serán necesarias para validar el producto final. El método usado se basó en las combinaciones que se administraron mediante exposiciones de luz azul pulsada (BPLED) y luz azul y verde combinadas (BGPLED) a frecuencias de 100, 200 y 400 Hz adicionadas a la iluminación ambiental (BLC). Los participantes fueron expuestos a 12 condiciones de luz diferentes en un experimento balanceado y contrapesado. Mediante la integración de medidas electroencefalográficas (EEG) y de constricción pupilar; los resultados sugirieron cambios significativos en las respuestas durante la interacción de BLC, LED y EEG. Las ondas beta mostraron una significancia estadística (p <0.05) en los niveles de activación cuando se expusieron a la luz BGPLED, además, la pupila reaccionó con una mayor constricción hacia la exposición a BGPLED que hacia la exposición BPLED monocromática, adicionalmente se demostró que un flujo continuo de pulsos puede proporcionar una irradiación igual a la que se emite en flujo continuo; se concluyó e identificó además la frecuencia (100 Hz) que mejor evoca estado de alerta encefalográfíca y sin afectar la percepción de los usuarios en cuanto a su percepción del ambiente de acuerdo a la evaluación cualitativa.

Abstract The main objective was to evaluate the stability and toxicity of a Solution Enhanced Dispersion by Supercritical Fluids (SEDS) formulated A. paniculata extract that was intended for food applications. The best formulated SEDS A. paniculata extract with improved dissolution of andrographolide (data not shown) was obtained using 25 mg/mL A. paniculata extract (maceration in acetone) and 6 mg/mL Eudragit L100-55 with acetone as feed solvent at the following SEDS co-precipitation conditions: 150 bar, 40 ̊C, 15 L/min CO2 flow rate (1 bar, 25 ̊C), 0.5 mL/min liquid feed flow. Sticky A. paniculata extract with 16% w/w andrographolide was transformed into SEDS co-precipitates concentrated with 20.4% w/w andrographolide. Only 20-30% of andrographolide was degraded after two-month storage under 5, 30, 45 ̊C at 75% relative humidity (RH). About 30-60% of andrographolide was degraded after addition into drinking water, orange drink, soybean milk for a day. This would imply its unstable nature after being dispersed and wetted in liquid food. SEDS co-precipitate was found to be practically acetone-free (< 0.1 ppm) by Headspace Gas Chromatography-Mass Spectrometry (GC-MS). This showed the capability of the SEDS process in stripping off acetone. Higher cytotoxic potential of SEDS co-precipitates (LC50 = 46.46 µg/mL) than extract (LC50 = 150.45 µg/mL) was observed.

BACKGROUND. Clostridium difficile-associated diarrhoea (CDAD) is a potentially life-threatening condition that is becoming increasingly common. A persistent burden of this infectious illness has been demonstrated over the past 4 years at Wits Donald Gordon Medical Centre (WDGMC), Johannesburg, South Africa, through implementation of active surveillance of hospital-acquired infections as part of the infection prevention and control programme. Oral treatment with metronidazole or vancomycin is recommended, but there is a major problem with symptomatic recurrence after treatment. Replacement of normal flora by the administration of donor stool through colonoscopy or nasogastric/duodenal routes is becoming increasingly popular. OBJECTIVES. To identify risk factors for the development of CDAD in patients referred for faecal microbiota transplant (FMT) and evaluate the safety of administration of donor stool as an outpatient procedure, including via the nasogastric route. METHODS. A retrospective record review of patients with recurrent CDAD referred for FMT at WDGMC between 1 January 2012 and 31 December 2016 was conducted. RESULTS. Twenty-seven patients were identified, all of whom fulfilled the criteria for recurrent CDAD. One-third were aged >65 years, and the majority were female. The most common risk factors were prior exposure to antibiotics or proton-pump inhibitors and underlying inflammatory bowel disease. Three procedures were carried out as inpatients and 24 in the outpatient gastroenterology unit. At 4-week follow-up, all patients reported clinical resolution of their diarrhoea after a single treatment and there were no recurrences. The FMT procedure was associated with no morbidity (with particular reference to the risk of aspiration when administered via the nasogastric route) or mortality. CONCLUSIONS. This case series confirms that FMT is a safe and effective therapy for recurrent CDAD. In most cases it can be administered via the nasogastric route in the outpatient department. We propose that the recently published South African Gastroenterology Society guidelines be reviewed with regard to recommendations for the route of administration of FMT and hospital admission. Meticulous prescription practice by clinicians practising in hospitals and outpatient settings, with particular attention to antimicrobials and chronic medication, is urgently required to prevent this debilitating and potentially life-threatening condition.

The recent researches on the tracking of binary offset carrier (BOC) modulated signals have been studied focusing on resolving the ambiguity problem caused by the multiple side-peaks in BOC autocorrelation. In this paper, we propose a novel unambiguous BOC tracking scheme with an improved tracking performance by using partial-pulses of BOC signals. Firstly, we observe that a sub-carrier consists of two partial rectangular pulses referred to as partial-pulses, and then, generate multiple partial-correlations composing the BOC autocorrelation. Finally, a correlation function with no side-peak is constructed by combining the partial-correlations, and then, a delay lock loop employing the proposed unambiguous correlation function adjusts the phase of the local BOC signals. From numerical results, it is confirmed that the proposed scheme provides a better tracking performance than the conventional schemes in terms of the tracking error standard deviation.

In orthogonal frequency division multiplexing (OFDM) systems, an integer part of a frequency offset (IFO) that causes ambiguity in data demodulation is estimated generally by comparing correlations between the received and local signals for IFO candidates. In this paper, we propose an IFO estimation scheme that provides a tradeoff between the estimation performance and the computational complexity including a conventional scheme as a special case. In the proposed scheme, template signals are formed by combining frequency-shifted training symbols, allowing the receiver to reduce the number of IFO candidates in the estimation process. Numerical results illustrate the tradeoff of the proposed scheme: The proposed scheme exhibits a tradeoff between the correct estimation probability and the computational complexity taking the number of the training symbols used to construct the template signal as a parameter.

This paper addresses the problem of detection of randomly arriving or departing primary user (PU) signals in cognitive radio systems. The detection problem of the dynamic PU signal is modeled as a binary hypothesis testing problem where the PU signal might randomly depart or arrive during the sensing period. Then, we detect the cyclostationarity of the PU signal using a test statistic derived from the spectral autocoherence function in dynamic PU signal environments. Numerical results show that the proposed scheme offers an improved spectrum sensing performance than the conventional energy detector for dynamic PU environments.

Addressing the equitable management of an international boundary river, this study aims to find the optimal strategy with regard to how to build multi-purpose dams and allocate the benefits and costs thereof. The interests of the riparian countries (North Korea and China) are defined in terms of the cooperative 2-person nonzero-sum game, and the Nash product is then calculated for various alternative strategies. The results reveal that the Kangkudong Dam and the Simpo Dam should be collaboratively constructed, and that the benefits of the 2 dams should be allocated according to relative demand in order to provide North Korea and China with sufficient benefits and to equitably address their conflicting interests. Furthermore, the suggested strategy was found to be optimal or at least quasi-optimal when the North Korean economy, which is regarded as a crucial source of uncertainty in this case, moved from a low-growth scenario to a high-growth scenario.

In Korea, antivenoms for the treatment of patients bitten by venomous snakes have been imported from Japan or China. Although there is cross-reactivity between these antibodies and venoms from snakes indigenous to Korea (e.g. Agkistrodon genus), protection is not optimal. Antivenoms specifically prepared to neutralize Korean snake venoms could be more effective, with fewer side effects. To this end, we established an infrastructure to develop national standards and created a standardized method to evaluate the efficacy of two horse-derived antivenoms using mouse lethal toxin test. Additionally, we determined the antivenoms neutralizing activity against lethal doses (LD50) of Agkistrodon halys (from Japan) and Jiangzhe Agkistrodon halys (from China) venoms. We also performed cross-neutralization tests using probit analysis on each pairing of venom and antivenom in order to check the possibility of using Jiangzhe A. halys venom as a substitute for A. halys venom, the current standard. Slope of A. halys venom with A. halys antivenom was 10.2 and that of A. halys venom with Jiangzhe A. halys antivenom was 9.6. However, Slope of Jiangzhe A. halys venom with A. halys antivenom was 4.7 while that of Jiangzhe A. halys venom with Jiangzhe A. halys antivenom was 11.5. Therefore, the significant difference in slope patterns suggests that Jiangzhe A. halys venom cannot be used as a substitute for the standard venom to test the anti-lethal toxin activity of antivenoms (p<0.05).

To establish Korea National Standards for venoms and antivenoms, it is necessary to have standardized assay methods. In this study, we standardized a method to evaluate the antihemorrhagic potency of two horse-derived antivenoms using rabbit intracutaneous injection. We expressed the capability of these antivenoms to neutralize the hemorrhagic activities triggered by the venoms of Agkistrodon halys from Japan and Jiangzhe Agkistrodon halys from China as Minimum Hemorrhagic Dose (MHD). We also performed cross-neutralization tests employing the parallel line assay on different pairings of venoms and antivenoms to check the possibility of using Jiangzhe Agkistrodon halys venom as a substitute for the standard Agkistrodon halys venom in measurements of the antihemorrhagic activity, since A. halys venom is not easily available. Slope function ratio (S.R.) was 0.957 for Agkistrodon halys venom either with Agkistrodon halys antivenom or with Jiangzhe Agkistrodon halys antivenom (p>0.05). Similarly, S.R. was 0.348 for Jiangzhe Agkistrodon halys venom either with Agkistrodon halys antivenom or with Jiangzhe Agkistrodon halys antivenom (p>0.05). Thus, in this study we established antihemorrhagic potency test methods for both Agkistrodon halys and Jiangzhe Agkistrodon halys antivenoms and we could also show it is possible to use Jiangzhe Agkistrodon halys venom as a standard.

A camera obscura technique was used to investigate the spatial distribution of fusion protons emitted from a small deuterium plasma focus device operated in its neutron-optimized regime (14 kV, 3 kJ, and 400 Pa D2 gas). An indium-foil activation detector was employed simultaneously to measure the shot-to-shot neutron yield. The camera obscura was positioned on the forward axis of the plasma focus, 12 cm from the tip of the hollow copper anode, covering a conical field-of-view of half-angle slightly less than 20 degrees. The nuclear track detector material PM-355 was used in the camera focal plane to register protons from the ²H(d, p)³H reaction, hence imaging the spatial distribution of fusion occurring in the plasma focus. A kapton film covering the camera entrance pupil served to protect the detector from the hot plasma jet; it also stopped completely all energetic charged particles other than the (<img src="http:/img/fbpe/bjp/v32n1/sigual.gif" align="absMiddle"> 3 MeV) fusion protons. Following chemical etching of the detector plates, the track parameters - size, circularity, average-grey-value and (x-y) position - |were measured by an automated scanning system comprising an optical microscope equiped with a CCD camera, motorized stage and focus-adjust, and interfaced to a PC computer. From the accumulated track data, representing 119 plasma focus shots, the imaged fusion density profile was obtained. A detailed Monte Carlo simulation program was used to interpret this profile. The results indicate that the beam-target mechanism, in which energetic deuterons emitted in a forwardly directed cone from the plasma focus pinch interact with the cold deuterium gas, accounts for 90 to 96% of the fusion production for our device. There is however clear evidence for a non-zero (4 to 10%) contribution emitted directly from the pinch region.