bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary resveratrol attenuated colitis and modulated gut microbiota in dextran sulfate sodium-treated mice
Authors: Li Fang , Han Yanhui , Cai Xiaokun , Gu Min , Sun Jin , Qi Ce , Goulette Tim , Song Mingyue , Li Zhengze , Xiao Hang
Published: December 2019

Dietary resveratrol altered the microbial composition and restored microbial community diversity in colitic mice, which was associated with the suppression of colitis in the mice.
Nano-immunoimaging
Authors: Wang Ping , Kim Taeho , Harada Masako , Contag Christopher , Huang Xuefei , Smith Bryan Ronain
Published: December 2019

Immunoimaging, stoked by the intriguing triumphs of immunotherapy, increasingly intersects with nanotechnology. Nanoimmunoimaging, the nascent field that emerged, applies nanoengineering principles to help resolve key challenges facing immunoimaging.
Konjac glucomannan-derived nitrogen-containing layered microporous carbon for high-performance supercapacitors
Authors: Lian Jie , Pang Dongqiang , Yang Chun , Xiong Lingshan , Cheng Ru , Yang Sihang , Lei Jia , Chen Tao , Yang Fan , Zhu Wenkun
Published: December 2019

Biomass-derived carbon-based materials represent a promising class of candidates for supercapacitors.
Evolutionary dynamics of natural product biosynthesis in bacteria
Authors: Chevrette Marc G. , Gutiérrez-García Karina , Selem-Mojica Nelly , Aguilar-Martínez César , Yañez-Olvera Alan , Ramos-Aboites Hilda E. , Hoskisson Paul A. , Barona-Gómez Francisco
Published: December 2019

We review known evolutionary mechanisms underlying the overwhelming chemical diversity of bacterial natural products biosynthesis, focusing on enzyme promiscuity and the evolution of enzymatic domains that enable metabolic traits.
Progress in BiFeO3-based heterostructures: materials, properties and applications
Authors: Yin Li , Mi Wenbo
Published: December 2019

The optical, electrical, magnetic, and valley properties and their interactions in morphology-varied BiFeO3-based heterostructures are highlighted, along with their applications.
Determination of total phosphorus in soil and sludge by an effective headspace gas chromatographic method
Authors: Zheng Yukai , Fu Weide , Zhu Rencheng , Hu Zhanbo , Chen Gang , Chai Xin-Sheng
Published: December 2019

This paper reported a novel method for the determination of total phosphorus (TP) content in soil and sludge by a headspace gas chromatography (HS-GC) method.
pH-responsive polymeric vesicles from branched copolymers
Authors: Zhou Jinglun , Li Linlin , Wang Weishan , Zhao Yang , Feng Shengyu
Published: December 2019

A new type of branched copolymer, poly(l-lactide)2-b-poly(l-glutamic acid), based on polypeptide PLGA is synthesized by the ring-opening polymerization of N-carboxyanhydride of γ-benzyl-l-glutamate with amino-terminated PLLA2–NH2 and subsequent deprotection.
Thermoresponsive P(HEMA-co-OEGMA) copolymers: synthesis, characteristics and solution behavior
Authors: Kasprów Maciej , Machnik Justyna , Otulakowski Łukasz , Dworak Andrzej , Trzebicka Barbara
Published: December 2019

Random, thermoresponsive copolymers of 2-hydroxyethyl methacrylate (HEMA) and oligo(ethylene glycol) methyl ether methacrylate Mn = 300 (OEGMA) were synthesized via ATRP and theirs behavior was studied in water and in buffer solution.
The importance of nanoscale confinement to electrocatalytic performance
Authors: Wordsworth Johanna , Benedetti Tania M. , Alinezhad Ali , Tilley Richard D. , Edwards Martin A. , Schuhmann Wolfgang , Gooding J. Justin
Published: December 2019

Nanoparticles mimicking the three-dimensional architecture of enzymes where the reaction occurs down a channel isolated from bulk solution, referred here as nanozymes, were used to explore the impact of nano-confinement on electrocatalytic reactions.
Photo-induced charge kinetic acceleration in ultrathin layered double hydroxide nanosheets boosts the oxygen evolution reaction
Authors: Ding Peng , Luo Fengting , Wang Pengdi , Xia Weiwei , Xu Xiaoyong , Hu Jingguo , Zeng Haibo
Published: December 2019

Photo-electro-integrated activation over LDH catalysts was demonstrated as an effective strategy to boost OER activity with free solar energy.
Emerging interface materials for electronics thermal management: experiments, modeling, and new opportunities
Authors: Cui Ying , Li Man , Hu Yongjie
Published: December 2019

State-of-the-art experiments and modeling, challenges, and future opportunities for developing high-performance interface materials for electronics thermal management.
A high performance UV–visible dual-band photodetector based on an inorganic Cs2SnI6 perovskite/ZnO heterojunction structure
Authors: Shao Dali , Zhu Weiguang , Xin Guoqing , Liu Xueqing , Wang Tianmeng , Shi Sufei , Lian Jie , Sawyer Shayla
Published: December 2019

Inorganic perovskite/ZnO heterojunction photodetector with UV-visible dual-band detection capability.
Association about dietary vitamin C intake on the risk of ovarian cancer: a meta-analysis
Authors: Long Yuhang , Fei Hui , Xu Sumei , Wen Jianzhen , Ye Lihua , Su Zhaojuan
Published: December 2019

Changes in dietary vitamin C intake have been related to the risks of various cancers. However, the association between dietary vitamin C intake and the risk of ovarian cancer has not been fully determined. A meta-analysis was performed to evaluate the relationship between vitamin C intake and ovarian cancer risk. Observational studies that evaluated the association between vitamin C intake and ovarian cancer risk were identified via systematic search of PubMed and Embase databases. A random-effect model was used to combine relative risk (RR) with corresponding 95% confidence intervals (CIs). As a result, 16 studies (5 cohort studies and 11 case–control studies) with 4553 cases and 439,741 participants were included. Pooled results showed that dietary vitamin C intake had non-significant association on the risk of ovarian cancer (RR = 0.95, 95%CI = 0.81–1.11, I2 = 52.1%, Pfor heterogeneity = 0.008). Subgroup analyses according to characteristics including geographic location and study design showed consistent results with the overall result. In summary, findings from the present study indicated that dietary vitamin C intake is not associated with the risk of ovarian cancer.
Voice Use in Daily Life Studied With a Portable Voice Accumulator in Individuals With Parkinson's Disease and Matched Healthy Controls
Authors: Gustafsson Joakim Körner , Södersten Maria , Ternström Sten , Schalling Ellika
Published: December 2019

Purpose

The purpose of this work was to study how voice use in daily life is impacted by Parkinson's disease (PD), specifically if there is a difference in voice sound level and phonation ratio during everyday activities for individuals with PD and matched healthy controls. A further aim was to study how variations in environmental noise impact voice use.

Method

Long-term registration of voice use during 1 week in daily life was performed for 21 participants with PD (11 male, 10 female) and 21 matched healthy controls using the portable voice accumulator VoxLog. Voice use was assessed through registrations of spontaneous speech in different ranges of environmental noise in daily life and in a controlled studio recording setting.

Results

Individuals with PD use their voice 50%–60% less than their matched healthy controls in daily life. The difference increases in high levels of environmental noise. Individuals with PD used an average voice sound level in daily life that was 8.11 dB (female) and 6.7 dB (male) lower than their matched healthy controls. Difference in mean voice sound level for individuals with PD and controls during spontaneous speech during a controlled studio registration was 3.0 dB for the female group and 4.1 dB for the male group.

Conclusions

The observed difference in voice use in daily life between individuals with PD and matched healthy controls is a 1st step to objectively quantify the impact of PD on communicative participation. The variations in voice use in different levels of environmental noise and when comparing controlled and variable environments support the idea that the study of voice use should include methods to assess function in less controlled situations outside the clinical setting.
Physiological Compensation for Advanced Bolus Location at Swallow Onset: A Retrospective Analysis in Healthy Seniors
Authors: Herzberg Erica G. , Brates Danielle , Molfenter Sonja M.
Published: December 2019

Purpose

Previous work has established that advanced bolus location at swallow onset (BLSO) alone is not correlated with an increased swallowing safety risk in healthy seniors. The primary goal of this retrospective study was to examine whether healthy seniors systematically alter their laryngeal vestibule closure reaction time (LVCrt) to maintain a safe swallow in the context of advanced BLSO. The secondary goal was to determine if longer LVCrt distinguished Penetration–Aspiration Scale (PAS; Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) scores of 1 versus 2.

Method

Videofluoroscopy studies from 43 healthy seniors (21 men, 22 women;
M
age
= 76.7 years,
SD
= 7.2) were analyzed. LVCrt was calculated for 3 × 5 ml and 3 × 20 ml thin liquid barium boluses per participant. PAS and BLSO (Modified Barium Swallow Impairment Profile Component 6) were scored for all swallows. Reliability (intraclass correlation coefficient > .75) was established on all measures. A linear mixed-effects regression was run to examine the effect of PAS and BLSO on LVCrt while controlling for bolus volume and repeated swallow trial.

Results

There was a main effect of BLSO (
F
= 4.6,
p
= .004) and PAS (
F
= 29.3,
p
< .001) on LVCrt. Post hoc pairwise comparisons revealed that LVCrt was significantly faster in BLSO scores of 3 (pyriforms) compared to scores of both 0 (posterior angle of the ramus) and 1 (valleculae). Significantly prolonged LVCrt was observed in PAS scores of 2 in comparison to 1. No significant main effects of bolus volume or trial, or interactions, were observed.

Conclusions

Our findings suggest that healthy seniors compensate for advanced BLSO by increasing their LVCrt. Furthermore, faster LVCrt was shown to distinguish PAS scores of 1 versus 2. Additional work should explore the relationship between LVCrt, BLSO, and PAS scores in dysphagic populations, specifically those with known sensory impairments.
Diversely polarised sparse array design with minimum interelement spacing constraint for polarised pattern synthesis
Authors: Shi Shuli , Xu Yougen , Zhao Kang , Huang Yunlin , Liu Zhiwen
Published: December 2019

The problem of optimised design of diversely polarised sparse array for joint synthesis of spatial and polarisation beampattern is addressed in this Letter. Two kinds of polarised array configurations, cocentred and non‐cocentred crossed‐dipole arrays, are considered. Minimum interelement spacing constraint along with non‐cocentred constraint are involved in the design methods by using two discrete linear operators. The optimisation process can be formulated as a mixed‐integer quadratically constrained programming problem which guarantees the optimal solution of the sparse array configuration. Comparison examples with state‐of‐the‐art method validate the advantages of the proposed method in terms of the reduction of required element number and the enlargement of adjacent element spacing.
Intelligent vehicle control at signal‐free intersection under mixed connected environment
Authors: Yang Hao , Oguchi Ken
Published: December 2019

Conflict vehicle movements at intersections are one bottleneck of traffic mobility on urban networks. Recently, with the development of connected vehicles, regulating conflict movements by controlling individual vehicles to improve intersection performance has attracted a lot of research efforts. This study aims at developing an advanced vehicle control system with connected vehicles to reduce vehicle delays at intersections without the help of signals. An intersection delay model is proposed to predict the total vehicle delay at one intersection and to search for the optimal speed control actions to manage traffic under mixed connected and non‐connected vehicle environment. The simulation experiments illustrate that the control system is able to reduce average vehicle delay by up to 95%, and the sensitivity analysis of vehicle demand and market penetrate rates of connected vehicles is also conducted to understand the benefits of the system at different traffic and connected vehicle environments.
Multi‐modal vehicle trajectory prediction based on mutual information
Authors: Fei Cong , He Xiangkun , Ji Xuewu
Published: December 2019

Autonomous vehicles need to have the ability to predict the motion of surrounding vehicles, which will help to avoid potential accidents and make the best decision to ensure safety and comfort. The interactions among vehicles and those between them and the uncertainty of driving intention make trajectory prediction a challenging task. This study presents a long short‐term memory (LSTM) model for the task of trajectory prediction to account for both the mutual information and the multi‐modal intention. The model consists of a data fusion encoder and a multi‐modal decoder. The data fusion encoder summarises the mutual information by multi‐LSTM with shared parameters and the multi‐modal decoder generates trajectories based on driving intention. In addition, mixture density network is added to output a probabilistic prediction which improves the reliability of prediction results. NGSIM data set is used for training and testing. The results show that the proposed model can better capture the interactive driving behaviour and outperforms the state‐of‐the‐art methods in root‐weighted square error of displacement and velocity.
Multistation coordinated and dynamic passenger inflow control for a metro line
Authors: Wang Xingrong , Wu Jianjun , Yang Xin , Guo Xin , Yin Haodong , Sun Huijun
Published: December 2019

Passenger inflow control is an efficient way to relieve peak passenger flow and reduce security risks in metro networks. However, station operators develop passenger inflow control strategies independently, thus ignore the interactions among stations and lines in the actual operation. Subsequently, the single‐fixed control intensity usually fails to satisfy dynamic temporal passenger demand, resulting in great stranded passengers. To address this problem, a coordinated and dynamic inflow control method is proposed to generate an optimal demand‐driven control pattern in metro systems. First, a mixed integer programming model with the concept of the equivalent time interval is formulated to minimise the total number of stranded passengers on one line. Second, special consideration is paid to the transfer passengers with the aim of ensuring the safety of transfer stations. Finally, an actual passenger flow and train operation data in Beijing Batong line is conducted to test the performance of the approach. Compared with the non‐coordinated and dynamic inflow control method, results show that the proposed model can balance the utilisation of transportation capacity and reduce the total number of stranded passengers by 20.6%. Sensitivity analysis results indicate that both transportation capacity and transfer capability are the main factors affecting the inflow control.
Power‐efficient full‐duplex K/Ka‐band phased array front‐end
Authors: Tabarani Filipe , Boccia Luigi , Calzona Domenico , Amendola Giandomenico , Schumacher Hermann
Published: December 2019

This study presents the first monolithically integrated full‐duplex front‐end for K/Ka satellite communication phased arrays. A 0.25 μm SiGe:C BiCMOS process was used to develop the integrated circuit. The receive and transmit channels are united into a common port through a novel duplexer. For each RF channel, the bias currents, the active channels and the power amplifier operation mode can be controlled through a serial bus. Amplitude and phase control are provided with fine granularity (65,536 states). In transmit mode, each channel provides 37.3 dB of gain with 12.9 dBm output power at 1‐dB compression. In receive mode, 33.7 dB gain is measured with a noise figure of 3.2 dB. The amplitude/phase root‐mean‐square errors within the transmit (29.5–30.8 GHz) and receive (19.7–21 GHz) bands are below 0.7 dB/ and 0.26 dB/, respectively. The chip occupies and it consumes 81 and 15.5 mW per transmit and receive channels, respectively. The use of a Doherty power amplifier with a novel dynamic adaptive bias circuit led to a 31% reduction of the total dc array power consumption.
Design of balanced‐to‐balanced filtering power divider with arbitrary power division ratio based on circular patch resonator
Authors: Liu Qianwen , Wang Jianpeng , Zhu Lei , Wu Wen
Published: December 2019

Here, a new balanced‐to‐balanced filtering power divider with an arbitrary power division ratio is proposed by utilising the circular patch resonator. To clarify the working principle, the resonant property of the circular patch resonator is firstly investigated. A prototype of the balanced‐to‐balanced power divider with arbitrary power division ratio is then developed. This prototype consists of only one circular patch resonator, three pairs of balanced ports, and two ports terminated with matching impedances. With this simple arrangement, the desired performance of a balanced‐to‐balanced power divider with an arbitrary power division ratio can be satisfactorily achieved at the resonant frequency of TM11. Afterwards, a second‐order filtering circuit is constructed. In this context, two circular patches are arranged at the two sides of the ground and good signal transmission is realised by virtue of proper coupling apertures etched on the ground. Apart from coupling, the apertures can be further used for harmonic suppression. Therefore, this proposed structure not only has improved in‐band and out‐of‐band performances, but also has good harmonic suppression. To verify the design concept, two balanced‐to‐balanced filtering power dividers with division ratios of 1:1 and 15:1 are finally designed and fabricated. All the measured results agree well with the simulated ones.
Modelling and optimisation of planar matrix transformer for high frequency regulated LLC converter
Authors: Wu Liang , Xiao Long , Zhao Jun , Chen Guozhu
Published: December 2019

For high‐frequency high‐current low‐voltage applications, planar matrix transformer for unregulated LLC converter has been adopted to achieve high power density and high efficiency. Compared to unregulated LLC converter, the phase shift between the primary current and the secondary current of the matrix transformer is larger in regulated LLC converter as a result of lower magnetising inductance. Thus, the conventional winding loss model is not applicable to the matrix transformer for regulated LLC converter. Aiming at this problem, an accurately winding dc resistance model and an analytic winding ac resistance model are proposed in this study to calculate the winding loss of the matrix transformer. In addition, lower magnetising inductance also causes more serious fringing field near the air gap. Then, a calculation method to model the winding loss due to the fringing field is investigated. With the proposed model, design and optimisation of the matrix transformer for regulated LLC converter are described in detail subsequently. The proposed model is verified by a Gallium Nitride based 400 W LLC converter prototype with a power density of 443 W/in3 and a peak efficiency of 96.1%.
Measuring galaxy-galaxy-galaxy-lensing with higher precision and accuracy
Authors: Linke Laila , Simon Patrick , Schneider Peter , Hilbert Stefan
Published: December 2019

Context. Galaxy-galaxy-galaxy lensing (G3L) is a powerful tool for constraining the three-point correlation between the galaxy and matter distribution and thereby models of galaxy evolution.

Aims. We propose three improvements to current measurements of G3L: (i) a weighting of lens galaxies according to their redshift difference, (ii) adaptive binning of the three-point correlation function, and (iii) accounting for the effect of lens magnification by the cosmic large-scale structure. Improvement (i) is designed to improve the precision of the G3L measurement, whereas improvements (ii) and (iii) remove biases of the estimator. We further show how the G3L signal can be converted from angular into physical scales.

Methods. The improvements were tested on simple mock data and simulated data based on the Millennium Run with an implemented semi-analytic galaxy model.

Results. Our improvements increase the signal-to-noise ratio by 35% on average at angular scales between 0.′1 and 10′ and physical scales between 0.02 and 2 h−1 Mpc. They also remove the bias of the G3L estimator at angular scales below 1′, which was originally up to 40%. The signal due to lens magnification is approximately 10% of the total signal.
The complete lithostratigraphic section of the geothermal wells in Rittershoffen (Upper Rhine Graben, eastern France): a key for future geothermal wells
Authors: Duringer Philippe , Aichholzer Coralie , Orciani Sergio , Genter Albert
Published: December 2019

Between 2012 and 2014, in Rittershoffen, in the Upper Rhine Graben, two geothermal boreholes (GRT-1 and GRT-2) reached the granitic basement at a depth of around 2150 m. The wells crossed about 1160 m of Cenozoic and 1050 m of Mesozoic. In the Cenozoic, these wells crossed the greatest part of the Eocene, the lower part of the Oligocene and a thinner Pliocene. The Quaternary is poorly represented (less than 10 m). In the Mesozoic, the wells crossed the Lower Dogger, the entire Lias and the entire Triassic. A reduced thickness of about 50 m of Upper Permian terminates the sedimentary column before entering into the granitic basement. A major erosional unconformity separates the Middle Jurassic from the Tertiary units (the Upper Jurassic, entire Cretaceous and Paleocene are absent). The Rittershoffen drilled doublets were the subject of particular attention concerning the acquisition of a very precise stratigraphic profile. In this paper, we give the recognition criteria for the fifty-seven formations crossed by the GRT-1 well and their upper and lower boundaries as well as their specific gamma ray signatures. The data are presented in four figures: a general complete log displaying the main sets and three detailed, precise logs showing the sedimentary formations overhanging the granitic basement: the Tertiary, the Jurassic, the Triassic, the Permian and the basement.
Rendre une faculté de médecine socialement responsable. Guide AMEE no 109
Authors: Boelen Charles , Pearson David , Kaufman Arthur , Rourke James , Woollard Robert , Marsh David C. , Gibbs Trevor
Published: December 2019

Problématique : Les systèmes de santé à travers le monde doivent faire face à une série de défis tels qu’une demande croissante des citoyens, le vieillissement de la population, les nombreux risques pour la santé y compris ceux liés à la dégradation de l’environnement et le fait de ressources toujours limitées. On attend des principaux acteurs de santé, institutions académiques et facultés de médecine incluses, qu’ils développent une vision et un engagement commun pour édifier un secteur de la santé qui soit plus efficient et de meilleure qualité. C’est dans cette perspective que Boelen et Heck ont défini le concept de « responsabilité sociale des facultés de médecine », un concept qui encourage, non seulement à former des professionnels de santé très compétents dans leur domaine, mais possédant aussi les aptitudes nécessaires pour répondre efficacement à l’évolution du système de santé et démontrer l’effet positif de leurs actions sur la population. Exégèse : La responsabilité sociale invite l’institution académique à réorienter ses missions de formation, de recherche et de service et à démontrer explicitement l’impact qu’elle peut avoir sur la population qu’elle s’est engagée à servir, donc à contribuer à améliorer le système de santé, en particulier par un partenariat mutuellement bénéfique avec les autres acteurs institutionnels de santé. Le but de ce guide est d’explorer le concept de responsabilité sociale, de le définir plus précisément, notamment par des exemples, et de proposer des voies pour surmonter les obstacles à sa matérialisation. Bien qu’une référence spécifique soit faite aux facultés de médecine, le concept de responsabilité sociale s’applique également à la formation de toutes les professions de santé.
Parametric multi-objective energy and cost analysis in the life cycle of nearly zero energy buildings − an exhaustive search approach
Authors: Weiss Tobias , Moser Christoph , Venus David , Berggren Björn , Togerro Ase
Published: December 2019

Possible cost saving potentials in planning and construction of high performing nearly zero energy buildings (nZEBs) with advanced energy standards are often not sufficiently assessed, as only a few, out of numerous possible variants of technology sets are considered in the traditional planning process. Often planning and analysis are not carried out in parallel, and the alternative technical options are discarded at an early stage. If, on the other hand, possible variants are realistically compared in the planning phase, a profound decision can be made. nZEB-design is also a multi-objective optimization problem where stakeholder interests' conflict with each other. This research addresses a methodological approach to better understand the effects that technical variables have on energy, environmental and economic performance over the whole life cycle of a multi-family residential building in Sweden. The research goal is to identify the most significant technical nZEB design variables organized into a consistent framework. In this paper, in a first step an exhaustive search method is assessed for a multi-family residential building in Sweden that systematically investigates all possible variant combinations. In a second step the derived results are applied to multiple objectives and optimisation goals for a multi-target decision-making framework so that different actors can decide between optimal solutions for different objectives. This approach seeks to explore a set of optimal solutions rather than to find a single optimal solution. On the one hand, a variety of technologies, such as insulation of the building envelope, ventilation or electricity and heat supply, and on the other hand a variation of the boundary conditions (such as observation period, user behaviour, energy price increases or CO2 costs) was investigated. The results were analysed energetically and economically over the life cycle of the building with the objectives of identifying coherences, deriving trends and optimizations over a time span of 40 years. The results show that the variance in the financing costs (20%) and the net present value (15%) is relatively low, whereas the primary energy demand (66%) and the CO2 (73%) emission vary in a broader range. The optimum cost curve in relation to CO2 emissions is very flat. Low emissions and energy requirements can, therefore, be achieved with different energy concepts as long as the envelope is very efficient. Due to the nature of an exhaustive search approach, it is also possible to find technical solution sets and design strategies with nearly equal financing cost and/or net present values, but with less primary energy consumption and/or CO2 emissions.
Multiple Sklerose 2019 – Update zu Diagnostik und Therapie
Authors: Flachenecker Peter
Published: December 2019

Die Multiple Sklerose ist eine chronisch-entzündliche und neurodegenerative Erkrankung des zentralen Nervensystems (ZNS), deren Pathogenese in einer fehlgeleiteten Immunreaktion autoreaktiver Zellen gegenüber Myelin und Axonen gesehen wird. Nach dem derzeitigen Wissensstand wird diese autoimmune Reaktion sowohl durch genetische als auch durch Umweltfaktoren modifiziert, was schließlich zur Markscheidenschädigung (Demyelinisierung) und axonalen Degeneration führt. Zwar sind die zugrunde liegenden Ursachen weiterhin unbekannt. Die umfangreichen Forschungsbemühungen der letzten Jahre haben aber zu wichtigen Erkenntnissen im Hinblick auf Epidemiologie und Diagnostik geführt und neue (immunologische) Therapieansätze ergeben.
Leitlinien bei Patienten mit Multipler Sklerose
Authors: Mehrholz Jan , Thomas Simone , Elsner Bernhard
Published: December 2019

Im klinischen Alltag gibt es viele Momente, in denen sich Therapeuten fragen, welche die beste Vorgehensweise oder die beste Strategie bei einer bestimmten klinischen oder anderen Problematik ist. Auf der Suche nach dazu hilfreichen Hinweisen gibt es mittlerweile eine Reihe von Leitlinien und Empfehlungen.
Alltagsorientierte Ansätze und Hilfsmittel
Authors: Böing Thorsten
Published: December 2019

Hilfsmittel dienen im Alltag der Patienten dem unmittelbaren Behinderungsausgleich und verbessern die Teilhabe. Sie bedürfen einer individuellen Identifikation und patientenspezifischen Anpassung. Idealerweise erfüllen sie die Gütekriterien Patientencompliance und Hilfsmitteladhärenz. Wie lassen sich diese Aspekte bei der Versorgung an Multiple Sklerose Erkrankter umsetzen?
Zweiwöchiges intensives Aufstehtraining verbessert Selbstständigkeit nach Schlaganfall
Authors: Mehrholz Jan
Published: December 2019

de Sousa DG, Harvey LA, Dorsch S et al. Two weeks of intensive sit-to-stand training in addition to usual care improves sit-to-stand ability in people who are unable to stand up independently after stroke: A randomised trial. J Physiother 2019; 3: 152–158
Itʼs all in Your Head! Einfluss des Mentalen Trainings auf den Kompetenzerwerb praktischer Fertigkeiten in der chirurgischen Lehre
Authors: Germanyuk Aleksandra , Sterz Jasmina , Stefanescu Christina , Voß Sebastian Herbert , Rüsseler Miriam
Published: December 2019

Einleitung Die chirurgische Aus- und Weiterbildung kann mit Hochleistungssport verglichen werden, da hier komplizierte Bewegungsabläufe und differenzierte Koordination in Perfektion vereint werden müssen. Daher scheint die Integration von sportwissenschaftlich etablierten und detailliert analysierten Trainingsmethoden, wie bspw. das Mentale Training, in die chirurgische Ausbildung sinnvoll zu sein. Das Ziel der vorliegenden Arbeit ist eine vergleichende Effektivitätsanalyse sowie eine Kostenanalyse zwischen Mentalem Training und dem traditionellen „See one, do one, …“.

Material und Methoden Studierende des 2. klinischen Semesters wurden im Rahmen des „Trainings praktischer Fertigkeiten“ als Bestandteil des Blockpraktikums Chirurgie in 2 Gruppen randomisiert: Die Kontrollgruppe wurde nach dem Prinzip „See one, do one, …“ im Modul Wundversorgung unterrichtet, die Studiengruppe mittels Mentalen Trainings. Als Beispiel einer komplexen chirurgischen Fertigkeit wurde die Wundversorgung bestehend aus dem Setzen einer Lokalanästhesie, dem sterilen Abdecken und Vorbereiten einer Wunde sowie der Einzelknopfnaht ausgewählt. Der Lernerfolg wurden zu 3 Messzeitpunkten erfasst: unmittelbar nach dem Training mittels eines formativen OSCE (Messzeitpunkt 1), 2 Wochen später mittels eines Free-recall-Tests (mündliche Abfrage mit offenen Fragen; Messzeitpunkt 2) sowie nach 5 – 14 Wochen in einem summativen OSCE (Messzeitpunkt 3).

Ergebnisse 123 Studierende konnten in die Studie eingeschlossen werden. Am 1. Messzeitpunkt zeigten die Studierenden der Gruppe „Mentales Training“ an der Station „steriles Abdecken“ signifikant bessere Ergebnisse (Gruppe „See one, do one, …“ 67,4% + 11,1; MT-Gruppe 71,6 + 10,6; p = 0,035). An anderen Stationen und zu anderen Zeitpunkten zeigten sich keine signifikanten Unterschiede zwischen den Gruppen. Die aufgestellte Kostenanalyse zeigt eine potenzielle Ersparnis durch das Mentale Training von 4067,68 € pro Semester durch den ressourcensparenden Umgang mit Material und Personal im Vergleich zur Methode des „See one, do one, …“.

Schlussfolgerung Mentales Training stellt in der curricularen Lehre im Fach Chirurgie eine Lehrmethode dar, in der die Studierenden mindestens gleiche, für komplexe Fertigkeiten sogar bessere Ergebnisse erzielen als mit der traditionellen Methode „See one, do one, …“. Gleichzeitig geht es mit einer Reduktion der Personal- und Materialkosten einher.
Diagnosis, Pathophysiology and Management of Hypercalcemia in Malignancy: A Review of the Literature
Authors: Asonitis Nikolaos , Angelousi Anna , Zafeiris Christos , Lambrou George I , Dontas Ismene , Kassi Eva
Published: December 2019

Hypercalcemia of malignancy is the most common life-threatening metabolic disorder in patients with advanced stage cancers and is a sign of poor prognosis. It usually presents with markedly elevated calcium level and is severely symptomatic. It is associated with hematological malignancies, such as multiple myeloma, non-Hodgkin lymphoma, leukemias and solid cancers, particularly renal and breast carcinomas as well as squamous cell carcinomas of any organ. Several mechanisms have been implicated in the development of hypercalcemia of malignancy amongst them the osteolytic related hypercalcemia, parathyroid hormone-related peptide (PTHrP) mediated hypercalcemia, extrarenal 1,25 dixydroxyvitamin D (calcitriol) mediated hypercalcemia and parathyroid hormone (PTH) related hypercalcemia either ectopic in origin or in patients with parathyroid carcinoma. Clinical history and and physical examination could point towards the correct diagnosis confirmed by the above-mentioned biochemical mediators of hypercalcemia. Early diagnosis and treatment lowering calcium levels in the blood can improve symptoms and the quality of life of these patients and avoid delays for further antitumor therapy.
Family-Centered Care in the Intensive CareUnit—What Does Best Practice Tell Us?
Authors: Ludmir Jonathan , Netzer Giora
Published: December 2019

Families in the intensive care unit (ICU) experience high-stress levels and are at risk of developing psychological symptoms including depression, anxiety, and posttraumatic stress disorder (PTSD). Family-centered care defines an approach that encompasses respect, compassion, and support for families. By alleviating stress and anxiety, this approach can increase family satisfaction, improve communication with staff, and decrease ICU length of stay. Family-centered care relies on an interdisciplinary approach. Its components include daily family-centered rounds, frequent family meetings, and ensuring an adequate family support environment. Each of the components of family-centered care depend on adequately trained clinical staff who are champion in empathetic communication and constantly support family member throughout an ICU stay.
Intraoperative Dexmedetomidine Maintains Hemodynamic Stability and Hastens Postoperative Recovery in Patients Undergoing Transsphenoidal Pituitary Surgery
Authors: Bala Renu , Chaturvedi Arvind , Pandia Mihir Prakash , Bithal Parmod K
Published: December 2019

BackgroundTranssphenoidal resection of pituitary tumors is the neurosurgical procedure of choice to excise most of the tumors of the sellar/suprasellar region. The main goals of anesthesia are maintenance of hemodynamic stability, provision of conditions that facilitate good surgical exposure, and a prompt and smooth emergence to allow neurological and visual assessment. Dexmedetomidine (Dex), a selective α-2 agonist, is known to maintain cardiovascular stability and anxiolysis and provide pain relief. Therefore, we hypothesized that intraoperative Dex will attenuate hemodynamic response to nasal speculum (NS) insertion, decrease analgesic requirement, and hasten postoperative recovery.

Materials and MethodsThis prospective, randomized, double-blind, placebo-controlled study was conducted in 60 adult patients of either sex, American Society of Anesthesiologists status I or II undergoing elective pituitary surgery for excision of pituitary adenoma. Randomization was done into two groups; Group D (n = 30) received Dex bolus 1 μg/kg over 10 minutes, followed by 0.5 μg/kg/h, and group control Group C (n = 30) received normal saline (0.9%) in a similar manner. A standard anesthesia technique comprising fentanyl, propofol, rocuronium, sevoflurane, nitrous oxide, and oxygen was used. Intraoperative monitoring was uniform and standardized in all the patients; cardiovascular perturbations, if any, were noted and managed appropriately. After completion of surgery, tracheal extubation was performed, and emergence time, extubation time, modified Aldrete score, sedation, pain, time for first analgesic, nausea, vomiting, and shivering were recorded.

ResultsIn both the groups, an increase in heart rate and blood pressure occurred at the time of laryngoscopy and intubation, NS insertion, and extubation, but it was more in Group C (p < 0.05). In Group D, intraoperative requirement of analgesic, neuromuscular relaxant, and inhalational anesthetic was lesser compared with Group C. Emergence time as well as visual analog scale at emergence was less in Group D.

ConclusionsIntraoperative Dex infusion is a reasonable choice in patients undergoing transsphenoidal pituitary surgery.
Spectrum of Nonepileptic Paroxysmal Events in Children from Southern India
Authors: Gowda Vykuntaraju K , Amoghimath Raghavendraswami , Benakappa Naveen , Shivappa Sanjay K
Published: December 2019

Background Nonepileptic paroxysmal events (NEPEs) present with episodes similar to epileptic seizures but without abnormal electrical discharge on electroencephalogram (EEG). NEPEs are commonly misdiagnosed as epilepsy. Epilepsy is diagnosed on the basis of a detailed history and examination. Emphasis during history to rule out the possibility of NEPE is important. The wrong diagnosis of epilepsy can lead to physical, psychological, and financial harm to the child and the family. Hence, this study was planned.

Objective The objective of the study is to evaluate clinical profile, frequency, and spectrum of NEPE in children.

Materials and Methods This is a prospective observational study. Patients with NEPE between January 2014 and August 2016 aged < 18 years were enrolled. NEPEs were diagnosed on the basis of history, home video, and EEG recordings. Patients were divided into different categories according to age, specific type of disorder, and system responsible. Patients were followed for their NEPE frequency and outcome.

Results A total of 3,660 children presented with paroxysmal events; of them 8% were diagnosed with NEPE. Patients diagnosed with NEPE were classified into three age groups on the basis of their age of onset of symptom; of the total 285 patients, there were 2 neonates (0.7%), 160 infants (56%), and 123 children and adolescents (43.1%). Fifty-eight percent patients were boys. The most common diagnoses were breath-holding spells 113 (39%), followed by syncope 38 (13.3%) and psychogenic nonepileptic seizures 37 (12.9%). About 9 and 5% of patients had concomitant epilepsy and developmental delay, respectively.

Conclusions NEPEs account for 8% of paroxysmal events. Most common NEPEs were breath-holding spells among infants and syncope and “psychogenic nonepileptic seizures” in children and adolescents.
Access to the Intensive Care Unit by Severe Head Injury Patients
Authors: Balogun James A. , Akwada Obioma , Awana Emily , Balogun Folusho M.
Published: December 2019

Background The management of severe traumatic brain injury is directed at avoidance of secondary brain injuries. The intensive care unit (ICU) provides the ideal environment to achieving improved survival and functional outcome. The study sets out to identify the factors that determine the access of patients with severe head injury presenting at our hospital, to the ICU and their impact on outcome.

Materials and Methods his was a longitudinal study at the University College Hospital, Ibadan. Data of all consecutive severe head injury patients over a 9-month period, presenting to the accident and emergency department, was collected and analyzed using descriptive statistics and chi-squared test. The level of significance was p < 0.05.

Result There were 36 males (80.0%) in our study, with road crashes (25; 79.5%) as the most common mechanism of injury. Most patients (33; 73.3%) were transferred to our center after initial care in another hospital. Though 31(68.9%) patients had access to the ICU, they were all delayed, with the most common reason for the delay being lack of ICU space. More patients who got admitted into ICU (14; 45.2%) were alive at 28 days into admission (p = 0.04). The females (6; 13.3%) significantly survived till 28 days on admission compared with males (p = 0.03), but there was no difference in the survival rates between children and adults.

Conclusion Our study underscores the need for ICU admission in these patients to optimize outcome and identify the nonavailability of beds, as the most important cause of delayed access, as well as the need for increased manpower capacity and organized resource utilization.
Effect of Intraoperative Blood Loss on Perioperative Complications and Neurological Outcome in Adult Patients Undergoing Elective Brain Tumor Surgery
Authors: Rajagopalan Vanitha , Chouhan Rajendra Singh , Pandia Mihir Prakash , Lamsal Ritesh , Rath Girija Prasad
Published: December 2019

Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited.

Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20–50%), Group C (>50–100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss.

Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender (p < 0.001), hypertension (p = 0.008), tumor size >5 cm (p < 0.001), high-grade glioma (p = 0.004), meningioma (p < 0.001), mass effect (p = 0.002), midline shift (p = 0.014), highly vascular tumors documented on preoperative imaging (p < 0.001), extended craniotomy approach (p = 0.002), intraoperative colloids use >1,000 mL (p < 0.001), intraoperative brain bulge (p = 0.03), intraoperative appearance as highly vascular tumor (p < 0.001), and duration of surgery >300 minutes (p < 0.001).

Conclusions Knowledge of these predictors may help anesthesiologists anticipate major blood loss during brain tumor surgery and be prepared to mitigate these complications to improve patient outcome.
Neutrophil-to-Lymphocyte Ratio: Can It Be Used as an Adjunct Tool to Predict Histopathological Grade of Brain Tumor?
Authors: Ashwath K. G. , Aggarwal Ashish , Praneeth Kokkula , Singla Navneet , Gupta Kirti
Published: December 2019

Background Since histopathology is available only after surgery, clinical condition and radiological characters of the tumor are important factors on which a clinician counsels the patient of brain tumor to take a decision regarding the management. Neutrophil lymphocyte ratio (NLR), a marker of inflammation can be used as a prognostic marker to predict the survival in high-grade gliomas and metastases. We evaluated the utility of NLR as an adjunct tool in predicting the histopathological grade of brain tumors.

Materials and Methods One hundred sixteen patients with a diagnosis of brain tumors planned for surgical excision or biopsy were enrolled in the study. NLR was estimated in the preoperative blood sample. Patients were grouped into low- and highgrade brain tumors and their mean NLRs were analyzed. Similar evaluation was carried out between the intra- and extra-axial tumors.

Results Mean age of the study group was 40.14 years with 61 males. Seventy-eight patients had low-grade tumor and 38 patients had high-grade tumor. Sixty patients had extra-axial tumors and 56 patients had intra-axial tumors. The mean NLR of low-grade tumors was 1.68 ± 0.53 and that of high-grade tumors was 3.12 ± 0.74. NLR > 2.4 can be used to identify high-grade brain tumors with a sensitivity of 80%, specificity of 92%, positive predictive value of 82.1%, negative predictive value of 91%, an excellent impact with likelihood ratio (+) of 10.1, and an odds ratio of 54.1. The mean NLR of extra-axial tumors was 1.68 + 0.62 and that of intra-axial tumors was 2.64 ± 0.91. These observations were statistically significant with p-value < 0.05.

Conclusions NLR is an easily available and inexpensive marker of systemic inflammation, which varies across different histopathological grades of brain tumors. Mean NLR is higher in high-grade tumors and also intra-axial tumors with a cutoff value of NLR > 2.4 and > 2.0, respectively.
Effectiveness of Caregivers’ Yoga Module on Psychological Distress and Mental Well-Being among Caregivers of Patients Admitted to Neurological Rehabilitation Wards of a Tertiary Care Institute, Bengaluru, Karnataka, India
Authors: Gandhi Sailaxmi , Palled Vinaya Kumar , Sahu Maya , Jagannathan Aarti , Khanna Meeka , Jose Amrutha
Published: December 2019

Background Caregivers of patients admitted to neurorehabilitation wards may experience higher psychological distress (PD) and poor mental well-being (MWB). This study aimed to empower caregivers to cope effectively with PD and maintain well-being by practicing yoga.

Materials and Methods A total of 34 caregivers were randomized to the experimental group (EG) and waitlisted control group in a multiphase manner. Data were collected using sociodemographic schedule, Kessler’s Psychological Distress scale–10, and Warwick–Edinburgh’s Mental Well-being Scale. Caregivers’ yoga module (CYM) consisting of satsanga (theory), asanas (postures), pranayama (breath control), imagery, meditation, and relaxation techniques was taught to those in the EG at 35 m/d for eight consecutive days. They were encouraged to continue on their own for another 3 weeks. Posttest data were collected from both groups on the 15th and 29th days. Analysis was done with IBM SPSS statistics version 22 (IBM Corp., Armonk, New York, United States).

Results There was statistically significant reduction of PD and improvement of MWB among caregivers of EG within (PD: F = 17.78, p < 0.001; MWB: F = 5.48, p < 0.03) and between (PD: F = 15.87, p < 0.001; MWB: F = 15.87, p < 0.01) the groups after the CYM. A significant negative correlation was found between pretest MWB and PD (r =–0.579, p < 0.01). Caregivers who were married and caregivers’ perception of poor improvement of patient condition were significantly associated with PD.

Conclusion Findings provide preliminary evidence for the effectiveness of CYM on PD and MWB among caregivers of patients admitted to neurorehabilitation wards.
Reflection and transmission of light by a half-space with a nonlocal response: A complex variable approach
Authors: Gutiérrez-Reyes E.
Published: December 2019

A solution of the electromagnetic reflection and transmission problem by a half-space of a simple material with a nonlocal response to external electric fields is investigated with the aid of several mathematical results of the complex variable theory, the Sokhotski relations, and the Hilbert transform. We found that the problem of reflection and transmission of electromagnetic radiation in the Fourier space is equivalent to an integral equation arising in the Riemann boundary problem. The classical results of Fresnel’s formulas for S polarization are recovered, and the special case of the reflection and transmission of light by a half-space of small spheres in the diluted regime of particle concentration is found to also follow Fresnel’s formula with effective optical properties.