Hepatocellular Carcinoma Screening With Computed Tomography Using the Arterial Enhancement Fraction With Radiologic-Pathologic Correlation.

OBJECTIVE The aim of this study was to investigate the performance of the arterial enhancement fraction (AEF) in multiphasic computed tomography (CT) acquisitions to detect hepatocellular carcinoma (HCC) in liver transplant recipients in correlation with the pathologic analysis of the corresponding liver explants. MATERIALS AND METHODS Fifty-five transplant recipients were analyzed: 35 patients with 108 histologically proven HCC lesions and 20 patients with end-stage liver disease without HCC. Six radiologists looked at the triphasic CT acquisitions with the AEF maps in a first readout. For the second readout without the AEF maps, 3 radiologists analyzed triphasic CT acquisitions (group 1), whereas the other 3 readers had 4 contrast acquisitions available (group 2). A jackknife free-response reader receiver operating characteristic analysis was used to compare the readout performance of the readers. Receiver operating characteristic analysis was used to determine the optimal cutoff value of the AEF. RESULTS The figure of merit (θ = 0.6935) for the conventional triphasic readout was significantly inferior compared with the triphasic readout with additional use of the AEF (θ = 0.7478, P < 0.0001) in group 1. There was no significant difference between the fourphasic conventional readout (θ = 0.7569) and the triphasic readout (θ = 0.7615, P = 0.7541) with the AEF in group 2. Without the AEF, HCC lesions were detected with a sensitivity of 30.7% (95% confidence interval [CI], 25.5%-36.4%) and a specificity of 97.1% (96.0%-98.0%) by group 1 looking at 3 CT acquisition phases and with a sensitivity of 42.1% (36.2%-48.1%) and a specificity of 97.5% (96.4%-98.3%) in group 2 looking at 4 CT acquisition phases. Using the AEF maps, both groups looking at the same 3 acquisition phases, the sensitivity was 47.7% (95% CI, 41.9%-53.5%) with a specificity of 97.4% (96.4%-98.3%) in group 1 and 49.8% (95% CI, 43.9%-55.8%)/97.6% (96.6%-98.4%) in group 2. The optimal cutoff for the AEF was 50%. CONCLUSION The AEF is a helpful tool to screen for HCC with CT. The use of the AEF maps may significantly improve HCC detection, which allows omitting the fourth CT acquisition phase and thus making a 25% reduction of radiation dose possible.

Oxygen Supplementing, Biocompatible Outer Membranes for Enhanced Performance of Implantable Glucose Sensors

Lack of linearity and sensitivity, oxygen dependence, biofouling and tissue inflammation hinder the development of implantable biosensors for continuous monitoring of glucose. Herein, we report the development of stacked outer membranes based on LBL/PVA hydrogels that improve sensor sensitivity, linearity, oxygen independence and counter biofouling and inflammation. While the inner LBL membrane affords tunable diffusivity, the outer PVA is capable of releasing anti-inflammatory drugs/tissue response modifying agents to counter acute and chronic inflammation, and to induce neo-angiogenesis at the implant site. Sensors were fabricated by immobilizing GOx enzyme on top of 50 μm platinum wires, followed by deposition of stacked LBL/PVA hydrogel membranes. The response of the sensors at 0.7V to various glucose concentrations was studied. Michelis-Menten analysis was performed to quantify sensor performance in terms of linearity and oxygen dependence. The interplay between sensor performance and inward glucose diffusivity was elucidated using (i) various LBL membranes and (ii) various freeze-thaw (FT) cycles of PVA. Incorporation of LBL/PVA stacked membranes resulted in an 8 fold increase in sensor linearity and a 9 fold decrease in oxygen dependence compared to controls. The enhancement in the sensor performance is attributed to (i) the oxygen storing capability of PVA hydrogel due to the formation of hydrophobic domains during its freezing/ thawing employed for its physical crosslinking and (ii) regulation of glucose flux by the inner LBL membrane. Such membranes offer significant advantages over presently available outer membranes in lieu of (i) their ability to control inflammation, (ii) their modulus that closely matches that of subcutaneous human tissue, (iii) non-necessity of reactive chemical crosslinking agents, (iv) tunable sensitivity and (v) supplemental storage of oxygen.

Everyone is; should healthcare? Outsourcing: Issues in strategic planning, organizational culture, and organizational ethics

Expenditures for personal health services in the United States have doubled over the last decade. They continue to outpace the growth rate of the gross national product. Costs for medical care have steadily increased at an annual rate well above the rate of inflation and have gradually outstripped payers' ability to meet their premiums. This limitation of resources justifies the ongoing healthcare reform strategies to maximize utilization and minimize costs. The majority of the cost-containment effort has focused on hospitals, as they account for about 40 percent of total health expenditures. Although good patient outcomes have long been identified as healthcare's central concern, continuing cost pressures from both regulatory reforms and the restructuring of healthcare financing have recently made improving fiscal performance an essential goal for healthcare organizations. ^ The search for financial performance, quality improvement, and fiscal accountability has led to outsourcing, which is the hiring of a third party to perform a task previously and traditionally done in-house. The incomparable nature and overwhelming dissimilarities between health and other commodities raise numerous administrative, organizational, policy and ethical issues for administrators who contemplate outsourcing. This evaluation of the outsourcing phenomenon, how it has developed and is currently practiced in healthcare, will explore the reasons that healthcare organizations gravitate toward outsourcing as a strategic management tool to cut costs in an environment of continuing escalating spending. ^ This dissertation has four major findings. First, it suggests that U.S. hospitals in FY2000 spent an estimated $61 billion in outsourcing. Second, it finds that the proportion of healthcare outsourcing highly correlates with several types of hospital controlling authorities and specialties. Third, it argues that healthcare outsourcing has implications in strategic organizational issues, professionalism, and organizational ethics that warrant further public policy discussions before expanding its limited use beyond hospital “hotel functions” and back office business processes. Finally, it devises an outsourcing suitability scale that organizations can utilize to ensure the most strategic option for outsourcing and concludes with some public policy implications and recommendations for its limited use. ^

Expression regulation of AP -2 gamma gene

AP-2γ is a member of the AP-2 transcription factor family, is highly enriched in the trophoblast cell lineage, and is essential for placenta development. In an effort to identify factors regulating AP-2γ gene expression we isolated and characterized the promoter and 5′ flanking region of the mouse and human AP-2γ genes. The transcription start site of the mouse AP-2γ gene was mapped by primer extension and 5′ RACE. Transient gene transfer studies showed that basal promoter activity resides within a highly conserved ∼200 by DNA sequence located immediately upstream of the transcription start site. The conserved region is highly GC-rich and lacks typical TATA or CCAAT boxes. Multiple potential Sp and AP-2 binding sites are clustered within this region. Electrophoretic mobility shift assays demonstrated that Sp1 and Sp3 bind to three sites in the promoter region of the mouse AP-2γ gene. Combined mutation of the three putative Sp sites reduced promoter activity by 80% in trophoblast and non-trophoblast cells, demonstrating the functional importance of these sites in AP-2γ gene expression. ^ Mutational analysis of the 5′-flanking region revealed a 117-bp positive regulatory region of the mouse AP-2γ gene located between −5700 and −5583 upstream of the transcription start site. This 117-bp positive regulatory element provided approximately 7-fold enhancement of reporter gene expression in cultured trophoblast cells. A C/EBP-Sp1 transcription factor-binding module is located in this DNA sequence. Electrophoretic mobility shift assays demonstrated that transcription factors Sp1, Sp3 and C/EBP bind to the enhancer element. Mutation of each protein-binding site reduced the enhanced expression significantly. Mutagenesis assays showed that two other protein-binding sites also contribute to the enhancer activity. In summary, we have shown that Sp1 and Sp3 bind to cis-regulatory elements located in the promoter region and contribute to basal promoter activity. We have identified a 117-bp positive regulatory element of AP-2γ gene, and we have shown that Sp and C/EBP proteins bind to the cis -regulatory elements and contribute to the enhanced gene expression. ^

Performance analysis of AlGaAs/GaAs tunnel junctions for ultra-high concentration photovoltaics

An n(++)-GaAs/p(++)-AlGaAs tunnel junction with a peak current density of 10 100Acm(-2) is developed. This device is a tunnel junction for multijunction solar cells, grown lattice-matched on standard GaAs or Ge substrates, with the highest peak current density ever reported. The voltage drop for a current density equivalent to the operation of the multijunction solar cell up to 10 000 suns is below 5 mV. Trap-assisted tunnelling is proposed to be behind this performance, which cannot be justified by simple band-to-band tunnelling. The metal-organic vapour-phase epitaxy growth conditions, which are in the limits of the transport-limited regime, and the heavy tellurium doping levels are the proposed origins of the defects enabling trap-assisted tunnelling. The hypothesis of trap-assisted tunnelling is supported by the observed annealing behaviour of the tunnel junctions, which cannot be explained in terms of dopant diffusion or passivation. For the integration of these tunnel junctions into a triple-junction solar cell, AlGaAs barrier layers are introduced to suppress the formation of parasitic junctions, but this is found to significantly degrade the performance of the tunnel junctions. However, the annealed tunnel junctions with barrier layers still exhibit a peak current density higher than 2500Acm(-2) and a voltage drop at 10 000 suns of around 20 mV, which are excellent properties for tunnel junctions and mean they can serve as low-loss interconnections in multijunction solar cells working at ultra-high concentrations.

Human midbrain precursors activate the expected developmental genetic program and differentiate long-term to functional A9 dopamine neurons in vitro. Enhancement by Bcl-XL

Understanding the molecular programs of the generation of human dopaminergic neurons (DAn) from their ventral mesencephalic (VM) precursors is of key importance for basic studies, progress in cell therapy, drug screening and pharmacology in the context of Parkinson's disease. The nature of human DAn precursors in vitro is poorly understood, their properties unstable, and their availability highly limited. Here we present positive evidence that human VM precursors retaining their genuine properties and long-term capacity to generate A9 type Substantia nigra human DAn (hVM1 model cell line) can be propagated in culture. During a one month differentiation, these cells activate all key genes needed to progress from pro-neural and prodopaminergic precursors to mature and functional DAn. For the first time, we demonstrate that gene cascades are correctly activated during differentiation, resulting in the generation of mature DAn. These DAn have morphological and functional properties undistinguishable from those generated by VM primary neuronal cultures. In addition, we have found that the forced expression of Bcl-XL induces an increase in the expression of key developmental genes (MSX1, NGN2), maintenance of PITX3 expression temporal profile, and also enhances genes involved in DAn long-term function, maintenance and survival (EN1, LMX1B, NURR1 and PITX3). As a result, Bcl-XL anticipates and enhances DAn generation.

Effect of concentration on the performance of quantum dot intermediate-band solar cells

Implementation of a high-efficiency quantum dot intermediate-band solar cell (QD-IBSC) must accompany a sufficient photocurrent generation via IB states. The demonstration of a QD-IBSC is presently undergoing two stages. The first is to develop a technology to fabricate high-density QD stacks or a superlattice of low defect density placed within the active region of a p-i-n SC, and the second is to realize half-filled IB states to maximize the photocurrent generation by two-step absorption of sub-bandgap photons. For this, we have investigated the effect of light concentration on the characteristics of QDSCs comprised of multi-layer stacks of self-organized InAs/GaNAs QDs grown with and without impurity doping in molecular beam epitaxy.

Impact of N2 plasma power discharge on AlGaN/GaN HEMT performance

The effects of power and time conditions of in situ N2 plasma treatment, prior to silicon nitride (SiN) passivation, were investigated on an AlGaN/GaN high-electron mobility transistor (HEMT). These studies reveal that N2 plasma power is a critical parameter to control the SiN/AlGaN interface quality, which directly affects the 2-D electron gas density. Significant enhancement in the HEMT characteristics was observed by using a low power N2 plasma pretreatment. In contrast, a marked gradual reduction in the maximum drain-source current density (IDS max) and maximum transconductance (gm max), as well as in fT and fmax, was observed as the N2 plasma power increases (up to 40% decrease for 210 W). Different mechanisms were proposed to be dominant as a function of the discharge power range. A good correlation was observed between the device electrical characteristics and the surface assessment by atomic force microscopy and Kelvin force microscopy techniques.

Silica final lens performance in laser fusion facilities: HiPER and LIFE

Nowadays, the projects LIFE (Laser Inertial Fusion Energy) in USA and HiPER (High Power Laser Energy Research) in Europe are the most advanced ones to demonstrate laser fusion energy viability. One of the main points of concern to properly achieve ignition is the performance of the final optics (lenses) under the severe irradiation conditions that take place in fusion facilities. In this paper, we calculate the radiation fluxes and doses as well as the radiation-induced temperature enhancement and colour centre formation in final lenses assuming realistic geometrical configurations for HiPER and LIFE. On these bases, the mechanical stresses generated by the established temperature gradients are evaluated showing that from a mechanical point of view lenses only fulfil specifications if ions resulting from the imploding target are mitigated. The absorption coefficient of the lenses is calculated during reactor startup and steady-state operation. The obtained results reveal the necessity of new solutions to tackle ignition problems during the startup process for HiPER. Finally, we evaluate the effect of temperature gradients on focal length changes and lens surface deformations. In summary, we discuss the capabilities and weak points of silica lenses and propose alternatives to overcome predictable problems

MedVir: 3D visual interface applied to gene profile analysis

The use of data mining techniques for the gene profile discovery of diseases, such as cancer, is becoming usual in many researches. These techniques do not usually analyze the relationships between genes in depth, depending on the different variety of manifestations of the disease (related to patients). This kind of analysis takes a considerable amount of time and is not always the focus of the research. However, it is crucial in order to generate personalized treatments to fight the disease. Thus, this research focuses on finding a mechanism for gene profile analysis to be used by the medical and biologist experts. Results: In this research, the MedVir framework is proposed. It is an intuitive mechanism based on the visualization of medical data such as gene profiles, patients, clinical data, etc. MedVir, which is based on an Evolutionary Optimization technique, is a Dimensionality Reduction (DR) approach that presents the data in a three dimensional space. Furthermore, thanks to Virtual Reality technology, MedVir allows the expert to interact with the data in order to tailor it to the experience and knowledge of the expert.

Bio-inspired enhancement of reputation systems for intelligent environments

Providing security to the emerging field of ambient intelligence will be difficult if we rely only on existing techniques, given their dynamic and heterogeneous nature. Moreover, security demands of these systems are expected to grow, as many applications will require accurate context modeling. In this work we propose an enhancement to the reputation systems traditionally deployed for securing these systems. Different anomaly detectors are combined using the immunological paradigm to optimize reputation system performance in response to evolving security requirements. As an example, the experiments show how a combination of detectors based on unsupervised techniques (self-organizing maps and genetic algorithms) can help to significantly reduce the global response time of the reputation system. The proposed solution offers many benefits: scalability, fast response to adversarial activities, ability to detect unknown attacks, high adaptability, and high ability in detecting and confining attacks. For these reasons, we believe that our solution is capable of coping with the dynamism of ambient intelligence systems and the growing requirements of security demands.

Electromagnetic interaction between a laser beam and semiconductor nanowires deposited on different substrates: Raman enhancement in Si Nanowires

Raman scattering of Si nanowires (NWs) presents antenna effects. The electromagnetic resonance depends on the electromagnetic coupling of the system laser/NW/substrate. The antenna effect of the Raman signal was measured in individual NWs deposited on different substrates, and also free standing NWs in air. The one phonon Raman band in NWs can reach high intensities depending on the system configuration; values of Raman intensity per unit volume more than a few hundred times with respect to bulk substrate can be obtainedRaman scattering of Si nanowires (NWs) presents antenna effects. The electromagnetic resonance depends on the electromagnetic coupling of the system laser/NW/substrate. The antenna effect of the Raman signal was measured in individual NWs deposited on different substrates, and also free standing NWs in air. The one phonon Raman band in NWs can reach high intensities depending on the system configuration; values of Raman intensity per unit volume more than a few hundred times with respect to bulk substrate can be obtained

Gene number in an invertebrate chordate, Ciona intestinalis

Gene number can be considered a pragmatic measure of biological complexity, but reliable data is scarce. Estimates for vertebrates are 50-100,000 genes per haploid genome, whereas invertebrate estimates fall below 25,000. We wished to test the hypothesis that the origin of vertebrates coincided with extensive gene creation. A prediction is that gene number will differ sharply between invertebrate and vertebrate members of the chordate phylum. A gene number estimation method requiring limited sequence sampling of genomic DNA was developed and validated by using data for Caenorhabditis elegans. Using the method, we estimated that the invertebrate chordate Ciona intestinalis has 15,500 protein-coding genes (±3,700). This number is significantly lower than gene numbers of vertebrate chordates, but similar to those of invertebrates in distantly related phyla. The data indicate that evolution of vertebrates was accompanied by a dramatic increase in protein-coding capacity of the genome.

Tropomyosin directly modulates actomyosin mechanical performance at the level of a single actin filament

Muscle contraction is the result of myosin cross-bridges (XBs) cyclically interacting with the actin-containing thin filament. This interaction is modulated by the thin filament regulatory proteins, troponin and tropomyosin (Tm). With the use of an in vitro motility assay, the role of Tm in myosin’s ability to generate force and motion was assessed. At saturating myosin surface densities, Tm had no effect on thin filament velocity. However, below 50% myosin saturation, a significant reduction in actin–Tm filament velocity was observed, with complete inhibition of movement occurring at 12.5% of saturating surface densities. Under similar conditions, actin filaments alone demonstrated no reduction in velocity. The effect of Tm on force generation was assessed at the level of a single thin filament. In the absence of Tm, isometric force was a linear function of the density of myosin on the motility surface. At 50% myosin surface saturation, the presence of Tm resulted in a 2-fold enhancement of force relative to actin alone. However, no further potentiation of force was observed with Tm at saturating myosin surface densities. These results indicate that, in the presence of Tm, the strong binding of myosin cooperatively activates the thin filament. The inhibition of velocity at low myosin densities and the potentiation of force at higher myosin densities suggest that Tm can directly modulate the kinetics of a single myosin XB and the recruitment of a population of XBs, respectively. At saturating myosin conditions, Tm does not appear to affect the recruitment or the kinetics of myosin XBs.