bluuebunny/crossref_metadata_2025 huggingface dataset:
Stabilization of direct numerical simulation for finite truncations of circular cumulant expansions
Authors: Tyulkina I V , Goldobin D S , Pikovsky A
Published: July 2019

We study a numerical instability of direct simulations with truncated equation chains for the “circular cumulant” representation and two approaches to its suppression. The approaches are tested for a chimera-bearing hierarchical population of coupled oscillators. The stabilization techniques can be efficiently applied without significant effect on the natural system dynamics within a finite vicinity of the Ott-Antonsen manifold for direct numerical simulations with up to 20 cumulants; with increasing deviation from the Ott-Antonsen manifold the stabilization becomes more problematic.
Multidisciplinary Approach to the Design of Superconducting Electrical Machines
Authors: Kovalev K , Penkin V , Ivanov N , Kosheleva N , Serovaev G
Published: July 2019

Compared to traditional machines, superconducting electrical machines have significant advantages, i.e: improved weight and dimensions, higher efficiency, lower values of inductive parameters, reduced noise level, greater stability when operating in electrical networks. Development of such machines requires the solution of a whole series of scientific and engineering problems related to many fields of science and technology. Along with the solution of traditional problems of the usual “warm” electrical engineering, one has to solve the problems associated with cooling of superconducting windings and the stability of their superconducting state under the action of external heat leakage, centrifugal and ponderomotive forces, as well as vibrations. The design of cryogenic machines should provide for the compensation of thermal compression of structural elements and windings during cooling process. This paper presents some interdisciplinary tasks, the solution of which will allow to reach a new level in the field of superconducting electrical machines and to create samples of electric motors and generators, surpassing all existing analogues in specific parameters.
On the Optimal Location of Several Peizoelectric Elements on the Structure Surface
Authors: Oshmarin Dmitrii A , Iurlov Maksim A , Sevodina Natalia V , Iurlova Nataliia A
Published: July 2019

In this paper, based on the solution of the natural vibration problem an approach for determining the best options for the arrangement of piezoelectric elements on the surface of a structure allowing an essential improvement of its dynamic characteristics is proposed. The condition for a maximum value of the generalized electromechanical coupling coefficient, which characterizes the fraction of the converted mechanical energy of vibrations into the electrical energy, is adopted as an optimality criterion. The performance of the proposed approach is demonstrated by solving an example problem of locating two piezoelectric elements on the surface of a spatial structure providing damping of its vibrations at the selected frequencies. The obtained results are substantiated by the frequency response plots of the electric potential, obtained for different options of placement of piezoelectric elements on the surface of a structure under forced steady-state vibrations.
An Algorithm for Identifying Texture Components in the Framework of Statistical Crystal Plasticity Models
Authors: Ostapovich K V , Trusov P V , Yanz A Yu
Published: July 2019

An approach based on involving clustering techniques to identify texture components for a given polycrystalline aggregate is formulated. A heuristic iterative clustering algorithm operating only with a sample of lattice orientations and the concept of closeness between them is proposed for this task. The mentioned closeness concept is introduced via a special pseudometric distance, which is induced by the natural Riemann metrics and takes the lattice symmetry into consideration. The developed procedure allows representing an inhomogeneous orientation distribution by localized clusters in the space of orientations and thus can be used to reduce the dimension of orientation distribution data in statistical crystal plasticity models. Two examples of such an application of the clustering procedure are provided.
Grain Structure Refinement Description in the Two-Level Statistical Crystal Plasticity Model
Authors: Ostanina T V , Shveykin A I , Trusov P V , Makarevich E S
Published: July 2019

As both self-consistent and direct multilevel models (suggesting solution of boundary value problems at the meso-level) are extremely resource intensive, nowadays statistical crystal plasticity models are supposed to be the most promising ones for modeling technological processes of thermo-mechanical treatment of materials. The statement of a boundary value problem at the current configuration in the rate form is preferable, as it is convenient for applying numerical methods. In this case, step-by-step solution with redefining the computational domain configuration (including contacting surfaces) is possible. The two-level (macro- and meso-level) statistical constitutive model for describing deformation of polycrystalline metals and alloys, being formulated in terms of the actual configuration in the rate form, is proposed. The flexible coordinate system at the meso-level is connected with the symmetry elements of the crystallites, which determines appropriate choice of the corotational derivative in the constitutive relation. The approximate model for describing grain structure refinement on the basis of considering the amount of accumulated inelastic deformation as an integral characteristic of the defect structure state is included into the model. The results of the test calculations for describing loading processes, being relevant for equal-channel angular pressing, are given.
Plateau-Rayleigh Instability of Ferrofluid Drop-Like Aggregates in Zero Magnetic Field
Authors: Ivanov A S
Published: July 2019

Experimental investigation was carried out in order to study the properties of droplike aggregates – the needle-shaped drops of condensed phase, which appear in magnetic fluids undergoing field-induced phase transition of the gas-liquid type. When the applied magnetic field is removed, the needle-shaped aggregates demonstrate the Plateau-Rayleigh instability and disintegrate into series of separate spherical drops due to the surface tension σ at the interface between the gas and liquid phases. The surface tension entirely depends on interparticle interactions, thus experimental investigation of σ allows us to analyse the influence of temperature and magnetic field on the interparticle interactions. It is shown that drop-like aggregates condensed at high temperature demonstrate higher surface tension, than the aggregates condensed at low temperature. This anomalous behaviour can be attributed to the high magnetic field intensity needed to cause the phase transition at high temperature.
Testing Mechanical Features of Rubber Composites under Biaxial Loading
Authors: Garishin Oleg K , Shadrin Vladimir V
Published: July 2019

The main object of studies were composites on the base of synthetic rubber filled with various nano- and micro particles, which are already used or intended to be used in the tire industry. Mechanical behavior of such materials under biaxial cyclic loading was studied experimentally. The tests were carried out using the four-vector test rig Zwick/Roell. It allows to define complex deformation trajectories in two mutually perpendicular directions independently. The test program consisted of two or three cycles of load-unload (with stops for relaxation) in one direction and then two or three more such cycles in the perpendicular one. Experiments made it possible to study viscous-elastic properties as well as the effects of softening and the occurrence of induced anisotropy in filled elastomers under the action of a biaxial load. In the case of pure rubber, they are practically absent, so unfilled system can be considered as elastic and isotropic. A different picture is observed for filled systems. All the tested composites become viscoelastic after filler input: a hysteresis loop appeared and its area (dissipative losses) enlarged with increasing amplitude of cyclic deform. Also the dependences of induced anisotropy of mechanical properties and softening on the type of filler in the composite were investigated.
Experimental study of electrical impedance in airways filled with electrolyte solution aerosol
Authors: Zuev A L , Mishlanov Ia V , Polyakov V B
Published: July 2019

This article presents the results of an experimental study of electrical impedance in a model cell through which the air flow containing aerosol particles of the 10% sodium chloride solution generated by an ultrasonic nebulizer passes. The active and capacitive components of admittance were determined at different values of alternating current frequency, flow rate and aerosol atomization intensity. Measurement results were compared with the most probable electrical conductivity models. An equivalent electrical circuit in the form of a parallel RC- circuit, which corresponds well to the obtained frequency dependences of impedance magnitude and phase shift angle, is proposed. In addition, a linear regression model describing the dependence of the impedance module logarithm on two parameters of the flow of aerosol particles at different electrical current frequencies is developed.
Diffraction Resonances of Acoustic Stresses in the Crystal Layer
Authors: Belyayev Y N
Published: July 2019

The six-beam scattering of elastic waves by a crystal film is investigated. Cases of symmetric diffraction of waves inside the crystal layer are analyzed. In this scattering geometry, the projections of the wave vectors on the normal to the film surface are pairwise equal to each other up to the sign. Under certain conditions, quasi-shear waves modulate the structure in the path of quasi-longitudinal waves. If the period of the modulated structure is close to the length of a quasi-longitudinal wave, the amplitude of oscillations of the latter is amplified. The explanation of this effect is similar to the description of parametric resonance.This effect is illustrated by examples of calculations of the scattering spectra of elastic waves by cubic and tetragonal crystals in a three-layer model. Calculations are based on the transfer matrix method.
Inhomogeneities and Extreme Fluctuations of Strains in Grains of Polycrystalline Materials
Authors: Shavshukov V E , Tashkinov A A
Published: July 2019

Inhomogeneity of strains in individual grains are calculated using the field-theoretical approach in the mechanics of polycrystalline materials. It is shown that the microstructure surrounding the grain strongly influences the amplitude of the non-uniformity of strains in the grain. In the random microstructure of a polycrystal, there are specific clusters of grains in which very large strain fluctuations are realized. The strains in these clusters exceed macrostrains several times. The patterns of such extreme clusters are presented. Extreme strain fluctuations in bulk grains exceed fluctuations in surface grains by 40%. This may be one of the reasons for the movement of sites of damage initiation in gygacycle fatigue mode from the surface of a polycrystalline sample into the bulk.
Heat Transfer by Steady Streaming in a Horizontal Annulus with Inner Heating at Boundary Vibration
Authors: Kozlov N V
Published: July 2019

Convection and heat transfer are studied experimentally in a horizontal annulus, the outer wall of which is formed by an elastic silicone tube, and the inner one – by a copper cylindrical heat exchanger. The working volume is filled with a viscous fluid. T he temperature of the outer boundary is kept constant. At the inner boundary, a constant heat generation power is maintained. The elastic outer wall is driven in a periodic motion by two linear motors, installed symmetrically to the left and to the right of the container and performing synchronous oscillations. Thermal measurements are carried out at steady state temperature. In the absence of vibrations, free convection is observed. Vibrations lead to the generation of steady averaged flows in the form of a system of eight pairs of rolls, parallel to the cylinder axis. Vibrational convection enhances heat transfer across the annulus. The structure of steady flows and the rate of heat transfer are determined by the interaction between two convective mechanisms.
Velocity Distribution in Rough Pipe: the Model Based on the Analytical Description of Resistance Curves in Nikuradse’s Experiments
Authors: Dudar O
Published: July 2019

Calculation and optimization of such complex systems as ventilating networks, water supply systems, etc. taking into account roughness of a surface and possible processes of heat and mass transfer demands use simple hydrodynamic models, which are at the same time sufficiently exact for engineering calculations. The goal of this paper is to develop such model. Prandtl’s model of a two-layer flow in the smooth pipe with the linear law of velocity distribution for a near-wall laminar layer and the logarithmic law for a turbulent core is used as a basis, which spreads to a case of rough pipes. The velocity profile equation and also the equations for the coordinate Yb
of the laminar and turbulent border and its velocity Ub
are derived. This paper is based on the use of the analytical description of Nikuradse’s experimental curves λ(Re,δ) (λ is the resistance coefficient, δ is the relative roughness) which earlier was found by the author. The dependence λ(Re*,δ) (Re* is the dynamic Reynolds number) is included into all above-mentioned equations. Results of numerical calculations of Yb
and Ub
as functions of Re* for the values of δ which are the same as in Nikuradse’s experiments are given. The calculation of velocity profiles for some values of Re* and δ is also fulfilled. Comparisons with the experimental velocity profiles obtained by Nikuradse demonstrate a good agreement.
Two-Phase System in a Rotating Cylindrical Cavity under the Transverse Vibrations
Authors: Karpunin I E , Kozlov N V
Published: July 2019

The effect of large-amplitude translational vibrations on the dynamics of a two-phase system (light cylinder in liquid or two immiscible liquids, placed in a rotating cylindrical cavity) is studied experimentally. The experiments are run at high rotation rate, when under the action of centrifugal force the light phase is located near the rotation axis. Vibrations are perpendicular to the rotation axis and their frequency is close to the rotation rate. When the frequencies coincide, the vibrations change the centrifugal field configuration. The light phase column shifts stationary in the rotating frame of reference.
Dynamics of Vapor-Gas Bubbles in a Liquid Near Solid Surfaces with Different Properties
Authors: Lyubimova T P , Rybkin K A , Fattalov O O , Filippov L O
Published: July 2019

In this paper, the dynamics of vapor-gas bubbles arising in a distilled water and watersalt solutions as a result of coalescence of cavitation bubbles formed under the action of ultrasound (US) near solid surfaces with different properties has been experimentally investigated. Experiments have shown a significant effect of salt concentration in water and properties of solid surface on the behavior of bubbles, both under the action of ultrasonic and after its shutdown. In distilled water, mobile bubbles were observed on hydrophilic surface of wood, most of which are detached from the surface and rise after US shutdown. Bubbles on the hydrophobic surface of fluoroplastic, on the contrary, remain motionless both during the exposure to ultrasonic and after its shutdown. In a 20% aqueous solution of NaCl under the action of ultrasound on the hydrophilic surface, the bubbles remain stationary, and at the time of the shutdown of the ultrasound only a small part of them rise. In similar conditions, mobile bubbles are observed on the hydrophobic surface that rise when the ultrasonic is switched off.
A method of determining geometry of cone beam CT scanner
Authors: Tischenko O , Nezhad N Saeid , Hoeschen C
Published: July 2019

The task of determining the geometry of a cone-beam CT scanner with flat panel detector and circular/spiral source trajectory is considered. Accomplishing this task implies analyzing projections of a set of points referred to as calibrating set or calibrating phantom. We take advantage of the fact that observed coordinates of a point’s projection are rational functions of the point’s location. Unknown coefficients of these functions can be recovered exactly from six projections of the point. Location of the source as well as position and orientation of the detector are determined in the scanner reference frame, which is constituted by rotation axis and central plane of the scanner. Two different projections of a calibrating set are enough to solve the task if the source trajectory is a circle. In applications where a shift of an object transversally to the central plane is required, two additional projections have to be collected in order to identify the direction of the shift. The developed formalism becomes especially simple when the detector is aligned with the rotation axis. In this case four projections of a single calibrating point rotated successfully about the rotation axis are sufficient. The error analysis carried out in the paper shows that the magnitude of deviation from the true values is of the order of the magnitude of measurement errors.
Full life course analysis of birdsong reveals maturation and senescence of highly repeatable song characteristics
Authors: Zipple Matthew N , Nowicki Stephen , Searcy William A , Peters Susan
Published: July 2019

Signalers may benefit in some contexts from advertising their ages, for example in courting potential mates. Receivers in turn may benefit from assessing a signaler’s age, even in cases where their doing so is against the signaler’s interests. Indicators of age contained in signals thus may have important fitness consequences for both signalers and receivers. In birds, males of many species have been shown to display delayed maturation of their songs, resulting in older males singing songs that are higher in quality in one or more characteristics. Conversely, it seems possible that songs might eventually deteriorate with age as an aspect behavioral senescence. Studies of birdsong long enough to test both possibilities are quite uncommon, with nearly all studies aspect of age-dependent changes in birdsong spanning 3 or fewer years of males’ lives. Here, we present the longest longitudinal analysis of male birdsong to date, in which we analyze songs recorded for 4–11 years of the lives of captive male swamp sparrows. We find that males displayed delayed maturation of three song characteristics: song rate, song length, and consistency between songs. Delayed maturation was followed by behavioral senescence of three characteristics: song rate, stereotypy within songs, and consistency between songs. Because song quality declined in males beyond 2 years of age, this evidence is inconsistent with a signaling system in which females both prefer increasingly older males and are able to accurately determine male age through song assessment. Rather, our evidence suggests that swamp sparrows should be able to use song to distinguish intermediate-aged males from 1-year-old and very old males.
KCNT1 epilepsy with migrating focal seizures shows a temporal sequence with poor outcome, high mortality and SUDEP
Authors: Kuchenbuch Mathieu , Barcia Giulia , Chemaly Nicole , Carme Emilie , Roubertie Agathe , Gibaud Marc , Van Bogaert Patrick , de Saint Martin Anne , Hirsch Edouard , Dubois Fanny , Sarret Catherine , Nguyen The Tich Sylvie , Laroche Cecile , des Portes Vincent , Billette de Villemeur Thierry , Barthez Marie-Anne , Auvin Stéphane , Bahi-Buisson Nadia , Desguerre Isabelle , Kaminska Anna , Benquet Pascal , Nabbout Rima
Published: July 2019

Data on KCNT1 epilepsy of infancy with migrating focal seizures are heterogeneous and incomplete. Kuchenbuch et al. refine the syndrome phenotype, showing a three-step temporal sequence, poor prognosis with acquired microcephaly, high prevalence of extra-neurological manifestations and early mortality, particularly due to SUDEP. Refining the electro-clinical spectrum should facilitate early diagnosis.
Improving the Use of Personal Protective Equipment: Applying Lessons Learned
Authors: Reddy Sujan C , Valderrama Amy L , Kuhar David T
Published: July 2019

Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.
Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections
Authors: White Nicole M , Barnett Adrian G , Hall Lisa , Mitchell Brett G , Farrington Alison , Halton Kate , Paterson David L , Riley Thomas V , Gardner Anne , Page Katie , Gericke Christian A , Graves Nicholas
Published: July 2019

Background

Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016–2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs.

Methods

A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices.

Results

Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices.

Conclusions

A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.
Shoal familiarity modulates effects of individual metabolism on vulnerability to capture by trawling
Authors: Hollins J P W , Thambithurai D , Van Leeuwen T E , Allan B , Koeck B , Bailey D , Killen S S
Published: July 2019

Impacts of fisheries-induced evolution may extend beyond life history traits to more cryptic aspects of biology, such as behaviour and physiology. Understanding roles of physiological traits in determining individual susceptibility to capture in fishing gears and how these mechanisms change across contexts is essential to evaluate the capacity of commercial fisheries to elicit phenotypic change in exploited populations. Previous work has shown that metabolic traits related to anaerobic swimming may determine individual susceptibility to capture in trawls, with fish exhibiting higher anaerobic performance more likely to evade capture. However, high densities of fish aggregated ahead of a trawl net may exacerbate the role of social interactions in determining an individual fish’s behaviour and likelihood of capture, yet the role of social environment in modulating relationships between individual physiological traits and vulnerability to capture in trawls remains unknown. By replicating the final moments of capture in a trawl using shoals of wild minnow (Phoxinus phoxinus), we investigated the role of individual metabolic traits in determining susceptibility to capture among shoals of both familiar and unfamiliar conspecifics. We expected that increased shoal cohesion and conformity of behaviour in shoals of familiar fish would lessen the role of individual metabolic traits in determining susceptibility to capture. However, the opposite pattern was observed, with individual fish exhibiting high anaerobic capacity less vulnerable to capture in the trawl net, but only when tested alongside familiar conspecifics. This pattern is likely due to stronger cohesion within familiar shoals, where maintaining a minimal distance from conspecifics, and thus staying ahead of the net, becomes limited by individual anaerobic swim performance. In contrast, lower shoal cohesion and synchronicity of behaviours within unfamiliar shoals may exacerbate the role of stochastic processes in determining susceptibility to capture, disrupting relationships between individual metabolic traits and vulnerability to capture.
Long-term outcomes of cryoballoon-based left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation
Authors: Yorgun Hikmet , Canpolat Uğur , Okşul Metin , Şener Yusuf Ziya , Ateş Ahmet Hakan , Crijns Harry J G M , Aytemir Kudret
Published: July 2019

Aims

Pulmonary vein isolation (PVI) alone in persistent atrial fibrillation (AF) is not as successful as in paroxysmal AF, and recent data indicate the key role of non-PV triggers. We aimed to assess the long-term safety and efficacy of left atrial appendage isolation (LAAi) as an adjunct to PVI using cryoballoon (CB) in persistent AF.

Methods and results

We compared 144 persistent AF patients (59 ± 10 years, 51% females) who underwent PVI combined with LAAi with a propensity-score matched cohort of 138 persistent AF patients (59 ± 6 years, 52% female) in whom PVI-only was performed. Baseline and follow-up data including electrocardiography (ECG), 24-h Holter ECG’s, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a mean of 30.5 ± 5.6 months follow-up, 85 (61.6%) patients in the PVI-only group and 109 (75.7%) patients in the PVI+LAAi group were free of ATa after the index procedure (P = 0.008). Ischaemic stroke/transient ischaemic attack was detected in 4 (2.9%) patients in PVI-only group and in 5 (3.5%) patients in the PVI+LAAi group (P = 0.784). Cox regression analysis revealed that the PVI-only strategy was found as a significant predictor for recurrence (hazard ratio 3.01, 95% confidence interval 1.81–5.03; P < 0.001).

Conclusions

Our findings indicated that CB-based LAAi+PVI was associated with a favourable efficacy compared to PVI-only strategy in patients with persistent AF. Although ischaemic event rates were similar between the groups, rigorous adherence to anticoagulation regime is paramount in order to prevent thrombo-embolic complications.
Biomarkers for Aging Identified in Cross-sectional Studies Tend to Be Non-causative
Authors: Nelson Paul G , Promislow Daniel E L , Masel Joanna
Published: July 2019

Biomarkers are important tools for diagnosis, prognosis, and identification of the causal factors of physiological conditions. Biomarkers are typically identified by correlating biological measurements with the status of a condition in a sample of subjects. Cross-sectional studies sample subjects at a single timepoint, whereas longitudinal studies follow a cohort through time. Identifying biomarkers of aging is subject to unique challenges. Individuals who age faster have intrinsically higher mortality rates and so are preferentially lost over time, in a phenomenon known as cohort selection. In this article, we use simulations to show that cohort selection biases cross-sectional analysis away from identifying causal loci of aging, to the point where cross-sectional studies are less likely to identify loci that cause aging than if loci had been chosen at random. We go on to show this bias can be corrected by incorporating correlates of mortality identified from longitudinal studies, allowing cross-sectional studies to effectively identify the causal factors of aging.
“In the Bengali Vocabulary, There Is No Such Word as Care Home”:Caring Experiences of UK Bangladeshi and Indian Family Carers of People Living With Dementia at Home
Authors: Herat-Gunaratne Ruminda , Cooper Claudia , Mukadam Naaheed , Rapaport Penny , Leverton Monica , Higgs Paul , Samus Quincy , Burton Alexandra
Published: July 2019

Background and Objectives

We aimed to explore experiences of South Asian carers of people with dementia receiving health or social care in the United Kingdom, purposively recruited to encompass a range of migration, economic and cultural experiences. While previous work in this area has reported carers’ understanding of, and attitudes to dementia, we explored how carers’ cultural identities and values influenced their experiences, negotiation of the caring role and relationship with services.

Research Design and Methods

We conducted semi-structured interviews with 10 Bangladeshi and Indian family carers of people living with dementia at home. We recruited participants from community settings in London and Bradford, UK. Interviews were audio recorded, transcribed and thematically analyzed.

Results

We identified 4 themes: an expectation and duty to care, expectation and duty as a barrier to accessing formal care (family carer reluctance, care recipient reluctance, and service organization), culturally (in)sensitive care, and the importance of support from informal care networks.

Discussion and Implications

Interviewees described tensions between generations with different understandings of familial care obligations. Expectations to manage led to burden and guilt, and the cost of caring, in terms of lost employment and relationships was striking. Unlike in previous studies, interviewees wanted to engage and be supported by services, but were frequently offered care models they could not accept. There was a tension between a state-provided care system obliged to provide care when there are no alternatives, and family carers who feel a duty to always provide alternatives. Informal social networks often provided valued support.
PapG subtype-specific binding characteristics of Escherichia coli towards globo-series glycosphingolipids of human kidney and bladder uroepithelial cells
Authors: Legros Nadine , Ptascheck Stefanie , Pohlentz Gottfried , Karch Helge , Dobrindt Ulrich , Müthing Johannes
Published: July 2019

Uropathogenic Escherichia coli (UPEC) are the primary cause of urinary tract infections (UTIs) in humans. P-fimbriae are key players for bacterial adherence to the uroepithelium through the Galα1–4Gal-binding PapG adhesin. The three identified classes I, II and III of PapG are supposed to adhere differently to host cell glycosphingolipids (GSLs) of the uroepithelial tract harboring a distal or internal Galα1–4Gal sequence. In this study, GSL binding characteristics were obtained in a nonradioactive adhesion assay using biotinylated E. coli UTI and urine isolates combined with enzyme-linked NeutrAvidin for detection. Initial experiments with reference globotriaosylceramide (Gb3Cer, Galα1–4Galβ1–4Glcβ1–1Cer), globotetraosylceramide (Gb4Cer, GalNAcβ1–3Galα1–4Galβ1–4Glcβ1–1Cer) and Forssman GSL (GalNAcα1–3GalNAcβ1–3Galα1–4Galβ1–4Glcβ1–1Cer) revealed balanced adhesion toward the three GSLs for PapG I–mediated attachment. In contrast, E. coli carrying PapG II or PapG III increasingly adhered to growing oligosaccharide chain lengths of Gb3Cer, Gb4Cer and Forssman GSL. Binding studies with GSLs from human A498 kidney and human T24 bladder epithelial cells, both being negative for the Forssman GSL, revealed the less abundant Gb4Cer vs. Gb3Cer as the prevalent receptor in A498 cells of E. coli expressing PapG II or PapG III. On the other hand, T24 cells exhibited a higher relative content of Gb4Cer vs. Gb3Cer alongside dominant binding of PapG II- or PapG III–harboring E. coli toward Gb4Cer and vastly lowered attachment to minor Gb3Cer. Further studies on PapG-mediated interaction with cell surface–exposed GSLs will improve our knowledge on the molecular mechanisms of P-fimbriae-mediated adhesion and may contribute to the development of antiadhesion therapeutics to combat UTIs.
Complete Breast MRI Response to Neoadjuvant Chemotherapy and Prediction of Pathologic Complete Response
Authors: Chen Christina A , Hayward Jessica H , Woodard Genevieve A , Ray Kimberly M , Starr Christopher J , Hylton Nola M , Joe Bonnie N , Lee Amie Y
Published: July 2019

Objective

To assess the negative predictive value (NPV) of breast MRI in detecting residual disease after neoadjuvant chemotherapy (NAC) in women with invasive breast cancer, overall and by tumor subtype.

Methods

An institutional review board approved retrospective study from January 2010 through December 2016 identified patients with invasive breast cancer who achieved complete MRI response to NAC, defined as the absence of residual enhancement in the tumor bed above background parenchymal enhancement. During the study period, it was our routine practice to assign a BI-RADS 1 or 2 assessment to these cases. The NPV was defined as the ability of a complete MRI response to predict pathologic complete response (pCR) at final surgical pathology. Statistical analyses were performed using a Fisher exact test.

Results

Among 244 patients who underwent MRI to assess NAC response, 38 (16%) were determined to have complete MRI response by the interpreting radiologist. Of these, 20/38 (53%) had pCR. Complete MRI response did not significantly predict pCR for the total group (P < 0.9). However, NPVs significantly varied by molecular subtype (P < 0.004). True negative MRIs by tumor subtype were 2/10 (20%) for hormone receptor (HR)+/HER2–, 3/10 (30%) for HR+/HER2+, 6/8 (75%) for HR–/HER+, and 9/10 (90%) for triple negative (TN) subtypes. Complete MRI response significantly predicted pCR for only the TN subtype (NPV 90%; P < 0.02).

Conclusions

In patients with complete MRI response, 53% had pCR. While MRI lacks sufficient NPV to obviate the need for surgical excision, it may add prognostic value for certain molecular subtypes. The TN subtype demonstrated the highest NPV.
The Association of Breast Pain with Malignancy
Authors: Holbrook Anna I , Zhang James , D’amico Kelly , Liu Yuan , Newell Mary S
Published: July 2019

Objective

Breast pain is a common reason for imaging evaluation; however, the limited literature available suggests a low incidence of malignancy with isolated pain. The goal of this study is to calculate the risk of cancer in patients with breast pain, and to compare to the screening mammography cancer detection rates.

Methods

This retrospective, institutional review board–approved study included all patients for whom a breast pain history sheet was filled out between November 3, 2013, and July 28, 2016. Those without at least two years of follow-up were excluded. From the medical record, any malignancy found at the site of pain at presentation or within two years was noted. Screening cancer detection rate was calculated from the mammography tracking software, and the Chi-square test was used to evaluate the significance of the difference between the cancer detection rates in patients with pain versus that detected by screening.

Results

Of 421 patients who met the inclusion criteria, 4 (1.0%) had cancer at the site of pain, with a rate of malignancy of 9.5/1000 (95% CI: 3.5/1000 to 25.2/1000). The screening cancer detection rate was 7.3/1000 (P = 0.403), which was not significantly different. All cancers occurred in patients with coexisting palpable abnormalities; none was found when pain was the only symptom.

Conclusion

The rate of malignancy in patients with breast pain did not differ significantly from that detected by screening mammography. In patients with isolated breast pain without a palpable abnormality, there were no cases of malignancy. Imaging patients for the sole purpose of evaluating breast pain may not be necessary.
Internet-Based Patient Education Prior to Colonoscopy: Prospective, Observational Study of a Single Center’s Implementation, with Objective Assessment of Bowel Preparation Quality and Patient Satisfaction
Authors: Trasolini Roberto , Nap-Hill Estello , Suzuki Matthew , Galorport Cherry , Yonge Jordan , Amar Jack , Bressler Brian , Ko Hin Hin , Lam Eric C S , Ramji Alnoor , Rosenfeld Gregory , Telford Jennifer J , Whittaker Scott , Enns Robert A
Published: July 2019

Background

Nonpharmacologic factors, including patient education, affect bowel preparation for colonoscopy. Optimal cleansing increases quality and reduces repeat procedures. This study prospectively analyzes use of an individualized online patient education module in place of traditional patient education.

Aims

To determine the effectiveness of online education for patients, measured by the proportion achieving sufficient bowel preparation. Secondary measures include assessment of patient satisfaction.

Methods

Prospective, single-center, observational study. Adults aged 19 years and over, with an e-mail account, scheduled for nonurgent colonoscopy, with English proficiency (or someone who could translate for them) were recruited. Demographics and objective bowel preparation quality were collected. Patient satisfaction was assessed via survey to assess clarity and usefulness of the module.

Results

Nine hundred consecutive patients completed the study. 84.6% of patients achieved adequate bowel preparation as measured by Boston bowel preparation score ≥ 6 and 90.1% scored adequately using Ottawa bowel preparation score ≤7. 94.2% and 92.1% of patients rated the web-education module as ‘very useful’ and ‘very clear’, respectively (≥8/10 on respective scales).

Conclusions

Our analysis suggests that internet-based patient education prior to colonoscopy is a viable option and achieves adequate bowel preparation. Preparation quality is comparable to previously published trials. Included patients found the process clear and useful. Pragmatic benefits of a web-based protocol such as time and cost savings were not formally assessed but may contribute to greater satisfaction for endoscopists and patients.
Myeloperoxidase Deficiency Manifesting as Pseudoneutropenia with Low Mean Peroxidase Index and High Monocyte Count in 4 Adult Patients
Authors: Roh Soongki , Ham Ji Yeon , Song Kyung Eun , Hwang Narae , Lee Nan Young
Published: July 2019

Myeloperoxidase (MPO) deficiency, one of the most common inherited phagocyte defects, and may exist as a transient phenomenon in combination with some clinical condition. Hematological analyzer ADVIA 2120i is used to identify the different types of leukocytes based on their size and staining properties, and by mean peroxidase index (MPXI). When MPO deficiency is present, neutrophils may be incorrectly counted as monocytes with lower MPXI values. We encountered a few cases of MPO deficiency with abnormally high monocytes counts resulting in pseudoneutropenia. These abnormal reports could lead to a mistaken diagnosis of severe neutropenia, which could result in unnecessary therapy. Manual differential count exhibited the normal differential count in every case. Every case yielded a markedly low MPXI value below -20. In conclusion, we suggest that MPO deficiency must be considered in patients especially when abnormally high monocyte counts combined with low MPXI values are observed.
3 Art. 2 GG: Protection of the Right of Personality
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the provisions of Art. 2 of the Grundgesetz (GG) with respect to the right to free development of personality. It first explains the scope of protection for the two fundamental-rights guarantees that comprise the right to free development of personality: general freedom of action and general right of personality. It then considers the question of interference with both rights and the constitutional justification of such interferences and cites decisions made by the Federal Constitutional Court in various cases, including those concerning the right to informational self-determination and the constitutionality of regulations on preventive detention. It also examines the conflicts between fundamental rights with respect to Art. 2 para. 1 GG before concluding with an analysis of the scope of protection for the right to life and physical integrity and the doctrine of the state's duty to protect.
4 Art. 3 GG: Equality Before the Law
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the general right to equality, which provides for equality before the law for all persons. It first provides an overview of the general principle of equality and the provisions contained in Art. 3 of the Grundgesetz (GG) requiring equality before the law (para. 1) and equal treatment of the sexes (para. 2), as well as provisions forbidding discrimination (para. 3). It then considers the three steps adopted by the Federal Constitutional Court to examine the principle of equality: unequal treatment under the law, equal treatment in fact within strict limits, and a general prohibition on arbitrariness. It then examines the jurisprudence of the Court with regard to the principle of equality and the prohibition on differentiation. It also analyses the equality of men and women under Art. 3 para. 2 GG and the legal consequences of violations of Art. 3 GG.
10 Art. 9 GG: Freedom of Association
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter deals with freedom of association which is guaranteed by Art. 9 of the Grundgesetz (GG). It first reviews the Federal Constitutional Court's decision concerning the constitutionality of the Codetermination Law of 1976, which expanded the rights of employees to jointly participate in corporate decision making. It then examines the Court's jurisprudence regarding the scope of protection for freedom of association, including the freedom to form income tax assistance associations. It also tackles the question of interference with the right of freedom of association, along with the constitutional justification of such interferences. Finally, it analyses the scope of protection for the fundamental right to form labour groups and employers' associations — or coalitions — to safeguard and improve working and economic conditions, focussing on cases relating to replacement of striking workers and wage-replacement payments in labour disputes.
12 Art. 11 GG: Freedom of Movement
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses freedom of movement, a fundamental right guaranteed by Art. 11 of the Grundgesetz (GG). It first examines the Federal Constitutional Court's jurisprudence regarding the scope of protection for freedom of movement, focussing on the issue of forced relocation and freedom to leave, before considering the limitations on freedom of movement in the form of residence assignments. In particular, it analyses the Court's decision in the case involving the Law on the Assignment of Residences governing the so-called later emigrants in Germany and their right to freedom of movement. Finally, it explains the relevance of Art. 11 GG to forced relocation to allow infrastructure and mining projects.
18 Art. 20 GG: Preface
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter provides an overview of three of the central structural principles of the German state and legal system that are found in Art. 20 of the Grundgesetz (GG): the republic principle, the democracy principle, and the federalism principle. Also included in this group of general principles is the rule of law principle, which is implicitly contained in Art. 20 para. 3 GG. The structural principles and state goals articulated in Art. 20 GG serve three primary functions: first, as foundational norms which serve as a catch-all standard for evaluating subjects not specifically regulated by GG; second, as interpretive guidelines for other provisions of GG and for the application of (statutory) laws; and third, as classification categories to which sub-principles are assigned, including the principle of proportionality. These structural principles and state goals are often in tension; a means of reconciling them is by using the concept of practical concordance.
21 Art. 20 GG: The Federal Principle
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the federalism principle as articulated in Art. 20 of the Grundgesetz (GG). It first examines the Federal Constitutional Court's jurisprudence concerning the idea that the federal government is an ‘entire state’ (Gesamtstaat). In particular, it considers the doctrine of the ‘tripartite federal state’ (‘entire state’ of the Federal Republic of Germany — federal government — states) and shows that the federal government is the entire state based on the doctrine of the ‘bipartite federal state’. It also explores the notion that the federal government is the ‘community of states’, the community of the federal government and the states, and the homogeneity of the federal and state governments. Finally, it explains the principle of loyalty to the federal state and the ensuing requirement of ‘federalism-friendly conduct’.
25 Art. 28 para. 2 GG: Autonomy of Municipalities
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter considers the relevant provisions of Art. 28 para. 2 of the Grundgesetz (GG) with regard to municipal autonomy. There are two contrasting views on what this autonomy means: the first argues that autonomy is the management of the community's own affairs, whereas the second describes it as indirect state administration. The chapter first examines the Federal Constitutional Court's jurisprudence concerning the question of whether Art. 28 para. 2 GG and the corresponding provisions of state constitutions guarantee the continued existence of individual municipalities and districts. It then discusses the responsibilities of municipalities in regulating the administration of local affairs, focussing on the principle of substantive allocation of responsibilities and the scope of the guarantee of municipal self-government. It also analyses the right of municipalities and associations of municipalities to carry out certain tasks independently, noting that the guarantee of independence guarantees local government entities as traditional ‘sovereign rights’.