bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve
Authors: Husso Annastiina , Airaksinen Juhani , Juvonen Tatu , Laine Mika , Dahlbacka Sebastian , Virtanen Marko , Niemelä Matti , Mäkikallio Timo , Savontaus Mikko , Eskola Markku , Raivio Peter , Valtola Antti , Biancari Fausto
Published: October 2020

Objectives

To compare the outcomes after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) for severe stenosis of bicuspid aortic valve (BAV).

Methods

We evaluated the early and mid-term outcome of patients with stenotic BAV who underwent SAVR or TAVR for aortic stenosis from the nationwide FinnValve registry.

Results

The FinnValve registry included 6463 AS patients and 1023 (15.8%) of them had BAV. SAVR was performed in 920 patients and TAVR in 103 patients with BAV. In the overall series, device success after TAVR was comparable to SAVR (94.2% vs. 97.1%, p = 0.115). TAVR was associated with increased rate of mild-to-severe paravalvular regurgitation (PVR) (19.4% vs. 7.9%, p < 0.0001) and of moderate-to-severe PVR (2.9% vs. 0.7%, p = 0.053). When newer-generation TAVR devices were evaluated, mild-to-severe PVR (11.9% vs. 7.9%, p = 0.223) and moderate-to-severe PVR (0% vs. 0.7%, p = 1.000) were comparable to SAVR. Type 1 N-L and type 2 L-R/R-N were the BAV morphologies with higher incidence of mild-to-severe PVR (37.5% and 100%, adjusted for new-generation prostheses p = 0.025) compared to other types of BAVs. Among 75 propensity score-matched cohorts, 30-day mortality was 1.3% after TAVR and 5.3% after SAVR (p = 0.375), and 2-year mortality was 9.7% after TAVR and 18.7% after SAVR (p = 0.268)

Conclusions

In patients with stenotic BAV, TAVR seems to achieve early and mid-term results comparable to SAVR. Type 1 N-L and type 2 L-R/R-N BAV morphologies had higher incidence of PVR. Larger studies evaluating different phenotypes of BAV are needed to confirm these findings.

Clinical trial registration

ClinicalTrials.gov Identifier: NCT03385915.

Graphic abstract
Primary culture of the rat spinal dorsal horn: a tool to investigate the effects of inflammatory stimulation on the afferent somatosensory system
Authors: Leisengang Stephan , Nürnberger Franz , Ott Daniela , Murgott Jolanta , Gerstberger Rüdiger , Rummel Christoph , Roth Joachim
Published: October 2020

One maladaptive consequence of inflammatory stimulation of the afferent somatosensory system is the manifestation of inflammatory pain. We established and characterized a neuroglial primary culture of the rat superficial dorsal horn (SDH) of the spinal cord to test responses of this structure to neurochemical, somatosensory, or inflammatory stimulation. Primary cultures of the rat SDH consist of neurons (43%), oligodendrocytes (35%), astrocytes (13%), and microglial cells (9%). Neurons of the SDH responded to cooling (7%), heating (18%), glutamate (80%), substance P (43%), prostaglandin E2 (8%), and KCl (100%) with transient increases in the intracellular calcium [Ca2+]i. Short-term stimulation of SDH primary cultures with LPS (10 μg/ml, 2 h) caused increased expression of pro-inflammatory cytokines, inflammatory transcription factors, and inducible enzymes responsible for inflammatory prostaglandin E2 synthesis. At the protein level, increased concentrations of tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6) were measured in the supernatants of LPS-stimulated SDH cultures and enhanced TNFα and IL-6 immunoreactivity was observed specifically in microglial cells. LPS-exposed microglial cells further showed increased nuclear immunoreactivity for the inflammatory transcription factors NFκB, NF-IL6, and pCREB, indicative of their activation. The short-term exposure to LPS further caused a reduction in the strength of substance P as opposed to glutamate-evoked Ca2+-signals in SDH neurons. However, long-term stimulation with a low dose of LPS (0.01 μg/ml, 24 h) resulted in a significant enhancement of glutamate-induced Ca2+ transients in SDH neurons, while substance P-evoked Ca2+ signals were not influenced. Our data suggest a critical role for microglial cells in the initiation of inflammatory processes within the SDH of the spinal cord, which are accompanied by a modulation of neuronal responses.
Neurorehabilitation in dystonia: a holistic perspective
Authors: Bradnam Lynley V. , Meiring Rebecca M. , Boyce Melani , McCambridge Alana
Published: October 2020

Rehabilitation for isolated forms of dystonia, such as cervical or focal hand dystonia, is usually targeted towards the affected body part and focuses on sensorimotor control and motor retraining of affected muscles. Recent evidence, has revealed people who live with dystonia experience a range of functional and non-motor deficits that reduce engagement in daily activities and health-related quality of life, which should be addressed with therapeutic interventions. These findings support the need for a holistic approach to the rehabilitation of dystonia, where assessment and treatments involve non-motor signs and symptoms, and not just the dystonic body part. Most studies have investigated Cervical Dystonia, and in this population, it is evident there is reduced postural control and walking speed, high fear of falling and actual falls, visual compensation for the impaired neck posture, and a myriad of non-motor symptoms including pain, fatigue, sleep disorders and anxiety and depression. In other populations of dystonia, there is also emerging evidence of falls and reduced vision-related quality of life, along with the inability to participate in physical activity due to worsening of dystonic symptoms during or after exercise. A holistic approach to dystonia would support the management of a wide range of symptoms and signs, that if properly addressed could meaningfully reduce disability and improve quality of life in people living with dystonia.
Mixed-integer optimal control problems with switching costs: a shortest path approach
Authors: Bestehorn Felix , Hansknecht Christoph , Kirches Christian , Manns Paul
Published: October 2020

We investigate an extension of Mixed-Integer Optimal Control Problems by adding switching costs, which enables the penalization of chattering and extends current modeling capabilities. The decomposition approach, consisting of solving a partial outer convexification to obtain a relaxed solution and using rounding schemes to obtain a discrete-valued control can still be applied, but the rounding turns out to be difficult in the presence of switching costs or switching constraints as the underlying problem is an Integer Program. We therefore reformulate the rounding problem into a shortest path problem on a parameterized family of directed acyclic graphs (DAGs). Solving the shortest path problem then allows to minimize switching costs and still maintain approximability with respect to the tunable DAG parameter $$\theta $$
θ
. We provide a proof of a runtime bound on equidistant rounding grids, where the bound is linear in time discretization granularity and polynomial in $$\theta $$
θ
. The efficacy of our approach is demonstrated by a comparison with an integer programming approach on a benchmark problem.
Twin Deficits: Evidence From Portugal, Italy, Spain and Greece
Authors: Panousis Konstantinos P. , Koukouritakis Minoas
Published: October 2020

Since the mid-2000s, internal and external imbalances have increased in many EU countries. This contributed to the debate over whether government budget deficits affect current account deficits, known as twin deficits hypothesis. It implies that public debt is actually a burden for future taxpayers and thus a dangerous way for budget financing. Therefore, the fiscal measures implemented by policymakers may also affect the current account. This article tests the twin deficits hypothesis for Portugal, Italy, Spain and Greece for the period 1999–2017. The empirical analysis presented in the article finds evidence that strongly supports this hypothesis only for Italy and Greece. For Portugal and Spain, however, the evidence is quite weak.
Die Bedeutung von Mieteinkommen und Immobilien für die Ungleichheit in Deutschland
Authors: Bartels Charlotte , Schröder Carsten
Published: October 2020

Immobilien haben an Bedeutung für die Einkommensungleichheit in Deutschland gewonnen. Der Anteil von Haushalten mit Einkommen aus Vermietung und Verpachtung hat zwischen 2002 und 2017 zugenommen. Mieteinkommen erklären einen wachsenden Anteil der Einkommensungleichheit in Deutschland. Veränderungen der Vermögensungleichheit werden hauptsächlich durch Kapitalgewinne aus Wohnungs- und Aktienkursen sowie durch unterschiedliche Sparquoten verursacht. Steigende Hauspreise verringern tendenziell die Vermögensungleichheit, während steigende Aktienpreise die Vermögensungleichheit vergrößern. In den 2010er Jahren hat der Anteil des Wohneigentums in den deutschen Bundesländern und über die verschiedenen Regionen hinweg zugenommen, insbesondere in städtischen Gebieten und größeren Kommunen. Somit profitierte ein steigender Anteil der deutschen Haushalte von steigenden Hauspreisen, und die Vermögensungleichheit hat sich zwischen 2002 und 2017 nicht wesentlich verändert. Wir dokumentieren erhebliche Unterschiede in Wohneigentum und -vermögen zwischen Ost- und Westdeutschland. Während in Westdeutschland 2017 etwa die Hälfte aller Haushalte in Immobilien investiert ist, liegt dieser Anteil in Ostdeutschland unter 40%. Im Jahr 2017 weisen die Haushalte in Bayern und Hamburg mit durchschnittlich mehr als 350.000 Euro das höchste Nettoimmobilienvermögen auf. In den ostdeutschen Bundesländern liegt das durchschnittliche Nettoimmobilienvermögen zwischen 100.000 und 150.000 Euro. Von 2012 bis 2017 ist das durchschnittliche Nettoimmobilienvermögen vor allem in großen Kommunen, Gemeinden und städtischen Regionen recht stark gestiegen. Das Betriebsvermögen erklärt mehr als die Hälfte der gesamten Nettovermögensungleichheit in Deutschland, gefolgt vom Nettoimmobilienvermögen.
Deindustrialisierung und Wahlverhalten
Authors: Schneider Lutz
Published: October 2020

Der politische Erfolg der Alternative für Deutschland (AfD) bei der Bundestagswahl 2017 lässt sich auch mit negativen Auswirkungen einer schrumpfenden Beschäftigung im verarbeitenden Gewerbe erklären. Dieser politische Effekt einer schrumpfenden Beschäftigung ist in Regionen mit vitaler industrieller Tradition besonders stark. Die durchgeführte Regression bestätigt, dass Regionen, die in den 1930er Jahren durch einen hohen Anteil an Beschäftigten in der verarbeitenden Industrie gekennzeichnet waren und die heute einen starken Rückgang der industriellen Beschäftigung verzeichnen, deutlich höhere Wahlergebnisse für die AfD haben.
In-plane and out-of-plane seismic damage of masonry infills in existing r.c. structures: the case study of De Gasperi-Battaglia school in Norcia
Authors: Mazza Fabio , Donnici Angelo
Published: October 2020

A significant correlation between the in-plane (IP) and out-of-plane (OOP) damage propagation of masonry infills (MIs) is frequently observed after strong earthquakes, posing a serious problem as regards vulnerability of public buildings such as schools. The present work is aimed at identifying the effects of different IP and OOP modelling assumptions of MIs on their seismic damage. To this end, the state secondary school De Gasperi-Battaglia in Norcia (Italy), object of monitoring by the Department of Civil Protection since 2000, is investigated for the heterogeneity of infill typologies. The school is composed of a basement and three storeys above ground level, with a reinforced concrete (r.c.) framed structure having a long-shaped rectangular plan. Two typologies can be identified in terms of transverse layout of MIs: (i) double-leaf interior partitions, made of hollow clay bricks; (ii) double-leaf exterior infill walls, constituted by facade solid bricks paired with hollow clay bricks. In addition, partial height infills in the longitudinal direction, due to classroom windows, make the columns susceptible to short column effects. MIs are represented by a five-element macro-model predicting both in-plane (IP) and out-of-plane (OOP) behaviour through a horizontal nonlinear truss and four diagonal nonlinear beam elements, respectively. Stiffness and strength values in the OOP direction are also reduced considering the evolution of the IP damage. Three assumptions are investigated for the behaviour of structural MIs: i.e. elastic both IP and OOP; inelastic IP and elastic OOP; inelastic both IP and OOP. Bare and infilled test structures are subjected to biaxial spectrum-compatible accelerograms, to evaluate the IP and OOP damage levels and effectiveness of the OOP simplified verification proposed by seismic codes.
Searching for Preclinical Models of Acute Decompensated Heart Failure: a Concise Narrative Overview and a Novel Swine Model
Authors: Olivari Davide , De Giorgio Daria , Staszewsky Lidia Irene , Fumagalli Francesca , Boccardo Antonio , Novelli Deborah , Manfredi Martina , Babini Giovanni , Luciani Anita , Ruggeri Laura , Magliocca Aurora , Zani Davide Danilo , Masson Serge , Belloli Angelo , Pravettoni Davide , Maiocchi Giuseppe , Latini Roberto , Ristagno Giuseppe
Published: October 2020

Purpose

Available animal models of acute heart failure (AHF) and their limitations are discussed herein. A novel and preclinically relevant porcine model of decompensated AHF (ADHF) is then presented.

Methods

Myocardial infarction (MI) was induced by occlusion of left anterior descending coronary artery in 17 male pigs (34 ± 4 kg). Two weeks later, ADHF was induced in the survived animals (n = 15) by occlusion of the circumflex coronary artery, associated with acute volume overload and increases in arterial blood pressure by vasoconstrictor infusion. After onset of ADHF, animals received 48-h iv infusion of either serelaxin (n = 9) or placebo (n = 6). The pathophysiology and progression of ADHF were described by combining evaluation of hemodynamics, echocardiography, bioimpedance, blood gasses, circulating biomarkers, and histology.

Results

During ADHF, animals showed reduced left ventricle (LV) ejection fraction < 30%, increased thoracic fluid content > 35%, pulmonary edema, and high pulmonary capillary wedge pressure ~ 30 mmHg (p < 0.01 vs. baseline). Other ADHF-induced alterations in hemodynamics, i.e., increased central venous and pulmonary arterial pressures; respiratory gas exchanges, i.e., respiratory acidosis with low arterial PO2 and high PCO2; and LV dysfunction, i.e., increased LV end-diastolic/systolic volumes, were observed (p < 0.01 vs. baseline). Representative increases in circulating cardiac biomarkers, i.e., troponin T, natriuretic peptide, and bio-adrenomedullin, occurred (p < 0.01 vs. baseline). Finally, elevated renal and liver biomarkers were observed 48 h after onset of ADHF. Mortality was ~ 50%. Serelaxin showed beneficial effects on congestion, but none on mortality.

Conclusion

This new model, resulting from a combination of chronic and acute MI, and volume and pressure overload, was able to reproduce all the typical clinical signs occurring during ADHF in a consistent and reproducible manner.
Differential regulation of extracellular matrix proteins in three recurrent liver metastases of a single patient with colorectal cancer
Authors: Voß Hannah , Wurlitzer Marcus , Smit Daniel J. , Ewald Florian , Alawi Malik , Spohn Michael , Indenbirken Daniela , Omidi Maryam , David Kerstin , Juhl Hartmut , Simon Ronald , Sauter Guido , Fischer Lutz , Izbicki Jakob R. , Molloy Mark P. , Nashan Björn , Schlüter Hartmut , Jücker Manfred
Published: October 2020

Colorectal cancer (CRC) patients suffer from the second highest mortality among all cancer entities. In half of all CRC patients, colorectal cancer liver metastases (CRLM) can be observed. Metastatic colorectal cancer is associated with poor overall survival and limited treatment options. Even after successful surgical resection of the primary tumor, metachronous liver metastases occur in one out of eight cases. The only available curative intended treatment is hepatic resection, but metachronous CRLM frequently recur after approximately 1 year. In this study, we performed a proteome analysis of three recurrent liver metastases of a single CRC patient by mass spectrometry. Despite surgical resection of the primary CRC and adjuvant chemotherapy plus cetuximab treatment, the patient developed three metachronous CRLM which occurred consecutively after 9, 21 and 31 months. We identified a set of 1132 proteins expressed in the three metachronous CRLM, of which 481 were differentially regulated, including 81 proteins that were associated with the extracellular matrix (ECM). 56 ECM associated proteins were identified as upregulated in the third metastasis, 26 (46%) of which were previously described as negative prognostic markers in CRC, including tenascin C, nidogen 1, fibulin 1 and vitronectin. These data may reflect an ascending trend of malignancy from the first to the third metachronous colorectal cancer liver metastasis. Additionally, the results indicate different ECM phenotypes for recurrent metachronous metastasis, associated with different grades of malignancy and highlights the importance of individual analysis of molecular features in different, consecutive metastatic events in a single patient.
A Defense of Privacy as Control
Authors: Menges Leonhard
Published: October 2020

Even though the idea that privacy is some kind of control is often presented as the standard view on privacy, there are powerful objections against it. The aim of this paper is to defend the control account of privacy against some particularly pressing challenges by proposing a new way to understand the relevant kind of control. The main thesis is that privacy should be analyzed in terms of source control, a notion that is adopted from discussions about moral responsibility.
JAK/STAT pathway and molecular mechanism in bone remodeling
Authors: Sanpaolo Eliana Rita , Rotondo Cinzia , Cici Daniela , Corrado Ada , Cantatore Francesco Paolo
Published: October 2020

JAK/STAT signaling pathway is involved in many diseases, including autoimmune diseases, which are characterized by a close interconnection between immune and bone system. JAK/STAT pathway is involved in bone homeostasis and plays an important role in proliferation and differentiation of some cell types, including osteoblasts and osteoclasts. Different molecules, such as cytokines, hormones, and growth factors are responsible for the activation of the JAK/STAT pathway, which leads, at the nuclear level, to start DNA transcription of target genes. Bone cells and remodeling process are often influenced by many cytokines, which act as strong stimulators of bone formation and resorption. Our aim, through careful research in literature, has been to provide an overview of the role of the JAK/STAT pathway in bone remodeling and on bone cells, with a focus on cytokines involved in bone turnover through this signal cascade. The JAK/STAT pathway, through the signal cascade activation mediated by the interaction with many cytokines, acts on bone cells and appears to be involved in bone remodeling process. However, many other studies are needed to completely understand the molecular mechanism underlying these bone process.
L’écoute musicale et ses enjeux dans Conversations avec le maître de Cécile Wajsbrot
Authors: Schulte Nordholt Annelies
Published: October 2020

Conversations avec le maître, the first volume of a series called ‘Haute mer’, is a novel about the experience of listening to music. Through conversations between a composer and an anonymous young woman, it conveys crucial aspects of musical listening and of its verbal expression. This article examines the functioning of dialogue between the two characters; moreover, it studies the relationship between creation and reception, as expressed in the novel. It also examines what is at stake in this dialogue: the power of art in its relation to reality, to History. How may music become the echo of contemporary catastrophes? The article offers a close reading of the novel’s descriptions of listening to music: what literary techniques enable the author to put it into words?
A local scale flood vulnerability assessment in the flood-prone area of Khyber Pakhtunkhwa, Pakistan
Authors: Nazeer Muhammad , Bork Hans-Rudolf
Published: October 2020

The central part of Khyber Pakhtunkhwa, Pakistan, is a highly flood-prone area of the province. The lives and assets of local communities are deeply vulnerable, attributed to the recurrence of seasonal floods. This concern has motivated decision-makers and the research community to develop and adopt best management practices to address flood vulnerability issues. One of the commonly used methods for evaluating flood vulnerability is empirical investigation using composite indicators. However, there are several issues with the available flood vulnerability literature, using composite indicators in the study area. The objectives of the current study are therefore twofold. On the one hand, it demonstrated in a comprehensive step-by-step approach to develop flood vulnerability composite indicator taking into account the broad range of stakeholders and the reliability of research. On the other hand, the flood vulnerability profile of the selected communities is being developed. Households’ survey was conducted in the selected communities using random sampling. The composite indicators of flood vulnerability were developed as the relative measure of flood vulnerability across the selected communities. A robustness check was also carried out using convenient techniques to address the problem of uncertainty. For such a purpose, the composite indicators of flood vulnerability were developed through various data rescaling, weighting, and aggregation schemes. The relative levels of flood vulnerability are identified across the selected communities, and the findings are illustrated by colored matrices. Different factors were identified for being responsible for the relative vulnerability of various communities. Jurisdiction-wise assessment of flood vulnerability reveals that communities located in Charsadda district are more vulnerable to flooding compared to those in Nowshera district. The study can facilitate a wide range of stakeholders and decision-makers not only to develop composite indicators for flood vulnerability but also to scientifically justify it as a management tool for flood risk reduction.
Different Approaches to Address Bullying in KiVa Schools: Adherence to Guidelines, Strategies Implemented, and Outcomes Obtained
Authors: Johander Eerika , Turunen Tiina , Garandeau Claire F. , Salmivalli Christina
Published: October 2020

We examined the extent to which school personnel implementing the KiVa® antibullying program in Finland during 2009–2015 systematically employed the program-recommended approaches (confronting or non-confronting), used one or the other depending on the bullying case (case-specific approach), or used their own adaptation when talking to perpetrators of bullying, and whether they organized follow-up meetings after such discussions. In addition to investigating adherence to program guidelines, we tested how effective these different approaches were in stopping bullying. Finally, we tested the contribution of follow-up meetings and the number of years KiVa had been implemented in a school to the effectiveness of the interventions, using reports from both school personnel and victimized students. The data were collected annually across 6 years via online questionnaires and included responses from 1221 primary and secondary schools. The school personnel were more likely to use the confronting approach than the non-confronting approach. Over time, rather than sticking to the two program-recommended approaches, they made adaptations (e.g., combining the two; using their own approach). Two-level regression analyses indicated that the discussions were equally effective, according to both personnel and victimized students, when the confronting, non-confronting, or a case-specific approach had been used. The discussions were less effective when the personnel used their own adaptation or could not specify the method used. Perceived effectiveness was higher in primary school and when follow-up meetings were organized systematically after each intervention, but unrelated to the number of years KiVa had been implemented.
Validity of the EQ-5D-5L questionnaire among the general population of Poland
Authors: Młyńczak Katarzyna , Golicki Dominik
Published: October 2020

Purpose

We aim to compare the psychometric properties of the EQ-5D-5L questionnaire with the EQ-5D-3L version and EQ VAS, based on a survey conducted in a sample representing the general adult population of Poland.

Methods

The survey comprised health-related quality of life (HRQoL) questionnaires: EQ-5D-5L, EQ VAS, SF-12 and EQ-5D-3L, together with demographic and socio-economic characteristics items. The EQ-5D index values were estimated based on a directly measured value set for Poland. The following psychometric properties were analysed: feasibility, distribution of responses, redistribution from EQ-5D-3L to EQ-5D-5L, inconsistencies, ceiling effects, informativity power and construct validity. We proposed a novel approach to the construct validity assessment, based on the use of a machine learning technique known as the random forest algorithm.

Results

From March to June 2014, 3978 subjects (aged 18–87, 53.2% female) were surveyed. The EQ-5D-5L questionnaire had a lower ceiling effect compared to EQ-5D-3L (38.0% vs 46.6%). Redistribution from EQ-5D-3L to EQ-5D-5L was similar for each dimension, and the mean inconsistency did not exceed 5%. The results of known-groups validation confirmed the hypothesis concerning the relationship between the EQ-5D index values and age, sex and occurrence of diabetes.

Conclusions

The EQ-5D-5L, in comparison with its EQ-5D-3L equivalent, showed similar or better psychometric properties within the general population of a country. We assessed the construct validity of the questionnaire with a novel approach that was based on a machine learning technique known as the random forest algorithm.
A systematic review of health state utility values for thyroid cancer
Authors: Houten Rachel , Fleeman Nigel , Kotas Eleanor , Boland Angela , Lambe Tosin , Duarte Rui
Published: October 2020

Purpose

Health state utility values are commonly used to inform economic evaluations and determine the cost-effectiveness of an intervention. The aim of this systematic review is to summarise the utility values available to represent the health-related quality of life (HRQoL) of patients with thyroid cancer.

Methods

Eight electronic databases were searched from January 1999 to April 2019 for studies which included assessment of HRQoL for patients with thyroid cancer. Utility estimates derived from multiple sources (EuroQol questionnaire 5-dimension (EQ-5D), time trade-off [TTO] and standard gamble [SG] methods) were extracted. In addition, utility estimates were generated by mapping from SF-36 and EORTC QLQ-30 to the EQ-5D-3L UK value set using published mapping algorithms.

Results

Searches identified 33 eligible studies. Twenty-six studies reported HRQoL for patients with differentiated thyroid cancer and seven studies for patients with general thyroid cancer. We identified studies which used different methods and tools to quantify the HRQoL in patients with thyroid cancer, such as the EQ-5D-3L, SF-36, EORTC QLQ-30 and SG and TTO techniques to estimate utility values. Utility estimates range from 0.205 (patients with low-risk differentiated thyroid cancer) to utility values approximate to the average UK population (following successful thyroidectomy surgery and radioiodine treatment). Utility estimates for different health states, across thyroid cancer sub-types and interventions are presented.

Conclusion

A catalogue of utility values is provided for use when carrying out economic modelling of thyroid cancer; by including mapped values, this approach broadens the scope of health states that can be considered within cost-effectiveness modelling.
Healthy, Wealthy, Wise, and Happy? Assessing Age Differences in Evaluative and Emotional Well-Being Among Mature Adults from Five Low- and Middle-Income Countries
Authors: Kieny Clémence , Flores Gabriela , Ingenhaag Michael , Maurer Jürgen
Published: October 2020

This study assesses the relationship between age and two dimensions of subjective well-being—evaluative and emotional—among mature adults from five low-and middle-income countries. We use data from the World Health Organization’s Study on Global AGEing and Adult Health to contrast the associations of age with subjective well-being when controlling only for gender with the corresponding partial associations when including a richer set of covariates. Adjusting only for gender, we find negative associations of age with evaluative well-being, while the corresponding age gradients for emotional well-being are relatively flat. By contrast, adjusting for further socio-demographic factors results in positive associations of age with both evaluative and emotional well-being. Oaxaca-Blinder decompositions allow us to explore the roles of two factors to account for any unadjusted age differences in subjective well-being: age-group differences in individual characteristics and life circumstances, and age-specific associations of individual characteristics and life circumstances with subjective well-being. While adverse circumstances such as poor health and low income contribute to lower levels of evaluative well-being among older adults, age per se is—ceteris paribus—positively associated with subjective well-being. Even in poorer countries, older age does not need to be a time of low subjective well-being. Policies aimed at preserving income and limiting or compensating old-age disability appear to be key for maintaining subjective well-being among older adults.
Prediction of obstructive sleep apnea: comparative performance of three screening instruments on the apnea-hypopnea index and the oxygen desaturation index
Authors: Veugen Christianne C. A. F. M. , Teunissen Emma M. , den Otter Leontine A. S. , Kos Martijn P. , Stokroos Robert J. , Copper Marcel P.
Published: October 2020

Purpose

To evaluate the performance of the NoSAS (neck, obesity, snoring, age, sex) score, the STOP-Bang (snoring, tiredness, observed apneas, blood pressure, body mass index, age, neck circumference, gender) questionnaire, and the Epworth sleepiness score (ESS) as a screening tool for obstructive sleep apnea (OSA) severity based on the apnea-hypopnea index (AHI) and the oxygen desaturation index (ODI).

Methods

Data from 235 patients who were monitored by ambulant polysomnography (PSG) were retrospectively analyzed. OSA severity was classified based on the AHI; similar classification categories were made based on the ODI. Discrimination was assessed by the area under the curve (AUC), while predictive parameters were calculated by four-grid contingency tables.

Results

The NoSAS score and the STOP-Bang questionnaire were both equally adequate screening tools for the AHI and the ODI with AUC ranging from 0.695 to 0.767 and 0.684 to 0.767, respectively. Both questionnaires perform better when used as a continuous variable. The ESS did not show adequate discrimination for screening for OSA (AUC ranging from 0.450 to 0.525). Male gender, age, and BMI proved to be the strongest individual predictors in this cohort.

Conclusion

This is the first study to evaluate the predictive performance of three different screening instruments with respect to both the AHI and the ODI. This is important, due to increasing evidence that the ODI may have a higher reproducibility in the clinical setting. The NoSAS score and the STOP-Bang questionnaire proved to be equally adequate to predict OSA severity based on both the AHI and the ODI.
Effect of continuous positive airway pressure on symptoms of anxiety and depression in patients with obstructive sleep apnea
Authors: Lundetræ Ragnhild Stokke , Saxvig Ingvild West , Lehmann Sverre , Bjorvatn Bjørn
Published: October 2020

Purpose

The objective was to assess the effect of continuous positive airway pressure (CPAP) on symptoms of anxiety and depression in patients with obstructive sleep apnea (OSA). We hypothesized a decrease in symptoms at follow-up, but that improvement relied on CPAP adherence.

Methods

The sample comprised 468 patients (mean age 55.5 years (SD = 12.0), 72% men) with OSA who received CPAP at a Norwegian hospital. OSA was diagnosed according to standard respiratory polygraphy. Mean baseline respiratory event index (REI) was 28.4 (SD = 20.6). Symptoms of anxiety and depression were assessed prior to CPAP treatment and at follow-up after a median of 20 weeks, range 6–52 weeks, with the Hospital Anxiety and Depression Scale (HADS). Patients were classified as CPAP adherent (≥ 4 h per night) or non-adherent (< 4 h per night).

Results

There was a significant decrease in anxiety scores from baseline (mean = 5.16, SD = 3.94) to follow-up (mean = 4.76, SD = 3.81), p < 0.001. Similarly, depression scores decreased from baseline (mean = 4.31, SD = 3.66) to follow-up (mean = 3.89, SD = 3.69), p < 0.001. Cohen’s d (0.19 and 0.18, respectively) indicated small effect sizes. The reduction in anxiety scores did not depend on CPAP adherence (no interaction effect F(1, 466) = 0.422, p = 0.516), whereas the reduction in depression scores were seen only in the CPAP adherent group (interaction effect F(1, 466) = 7.738, p = 0.006).

Conclusions

We found a decrease in symptoms of anxiety and depression from baseline to follow-up of CPAP treatment. The improvement in symptoms of depression was depending on CPAP adherence. This underlines the importance of adherence for optimal effect of CPAP treatment.
Intelligent lightweight structures for hybrid machine tools
Authors: Möhring H. -Christian , Müller Matthias , Krieger Jens , Multhoff Jörg , Plagge Christian , de Wit Jesper , Misch Sandra
Published: October 2020

In order to improve the competitiveness on the global machine tool markets, a permanent development of new solutions and optimization of existing technologies is necessary. Besides traditional business areas, like Europe, Asia and the US, emerging countries provide interesting potential. Currently, the setup and operation of precise machine tools in these areas possesses some challenges. As an example, the foundation of the machines is often not as stable as assumed during the layout and design phase. Furthermore, the thermal boundary conditions are often characterized by much higher differences of the ambient temperature during the daily operational time compared to European conditions. These influences affect especially the performance of medium sized machine tools. Within the joint project HYBRIDi, funded by the Federal Ministry of Education and Research (BMBF) supported by the Projektträger Karlsruhe (PTKA), partners from industry and research created, realized and investigated new intelligent lightweight machine slide structures in order to overcome the named challenges. In particular, two variants of a hybrid material z-slide (RAM) with integrated sensors were built and analyzed with respect to advantages in terms of mass reduction, static and dynamic stiffness, dynamic positioning accuracy as well as thermal behavior. This paper presents the developments and results of the project.
Modeling of vacuum grippers for the design of energy efficient vacuum-based handling processes
Authors: Gabriel Felix , Fahning Markus , Meiners Julia , Dietrich Franz , Dröder Klaus
Published: October 2020

Vacuum-based handling is widely used in industrial production systems, particularly for hand-ling of sheet metal parts. The process design for such handling tasks is mostly based on approximate calculations and best-practice experience. Due to the lack of detailed knowledge about the parameters that significantly influence the seal and force transmission behavior of vacuum grippers, these uncertainties are encountered by oversizing the gripping system by a defined safety margin. A model-based approach offers the potential to overcome this limitation and to dimension the gripping system based on a more exact prediction of the expected maximum loads and the resulting gripper deformation. In this work, we introduce an experiment-based modeling method that considers the dynamic deformation behavior of vacuum grippers in interaction with the specific gripper-object combination. In addition, we demonstrate that for these specific gripper-object combinations the gripper deformation is reversible up to a certain limit. This motivates to deliberately allow for a gripper deformation within this stability range. Finally, we demonstrate the validity of the proposed modeling method and give an outlook on how this method can be implemented for robot trajectory optimization and, based on that, enable an increase of the energy efficiency of vacuum-based handling of up to 85%.
Putting the French Duty of Vigilance Law in Context: Towards Corporate Accountability for Human Rights Violations in the Global South?
Authors: Schilling-Vacaflor Almut
Published: October 2020

The adoption of the French Duty of Vigilance law has been celebrated as a milestone for advancing the transnational business and human rights regime. The law can contribute to harden corporate accountability by challenging the “separation principle” of transnational companies and by obligating companies to report on their duty of vigilance. However, the question of whether the law actually contributes to human rights and environmental protection along global supply chains requires empirically grounded research that connects processes in home and host state countries. This paper contributes to such a new research agenda by linking political ecology literature and empirical insights from the Global South to research on due diligence regulations. With reference to field research data on contestations between the oil and gas company Total E&P and indigenous communities in Bolivia, I argue that the burden of proof and contestations over valid knowledge represent major obstacles when trying to establish legal liability.
Improving and monitoring the magnetic pulse welding process between dissimilar metals
Authors: Bellmann Joerg , Schettler Sebastian , Schulze Sebastian , Wagner Markus , Standfuss Jens , Zimmermann Martina , Beyer Eckhard , Leyens Christoph
Published: October 2020

Conventional fusion welding of dissimilar metals is often limited due to the different thermo-physical properties of the joining partners. In consequence, brittle intermetallic phases (IMC) can occur. Utilizing a pressure welding process like magnetic pulse welding (MPW) reduces the risk of IMCs significantly. Furthermore, this welding process has an outstanding short process duration in the range of a few microseconds, which makes it predestined for mass production. At the same time, this advantage challenges the process observation, inline-quality assurance hardware, and the design of the tool coils. The paper presents two strategies for reducing the energy input during MPW to increase the tool coil lifetime. The first approach, the introduction of a reactive nickel interlayer between steel and aluminum, leads to a significant welding energy reduction. Compared to aluminum samples joined by laser welding, the load-bearing capability of the resulting hybrid MPW driveshaft samples is higher in static torsion tests and similar in cyclic tests. The second approach is based on a novel process monitoring system that helps to analyze the characteristic light emission. The capability of the process monitoring system is presented on the example of a MPW-joined multimaterial part made of stainless steel, aluminum, and copper.
Levothyroxine and insulin requirement in autoimmune polyglandular type 3 syndrome: a real-life study
Authors: Guarnotta V. , Pillitteri G. , Gambino G. , Radellini S. , Vigneri E. , Pizzolanti G. , Giordano C.
Published: October 2020

Purpose

To evaluate factors influencing the insulin and levothyroxine requirement in patients with autoimmune polyglandular syndrome type 3 (APS-3) vs. patients with type 1 diabetes mellitus (T1DM) and autoimmune hypothyroidism (AH) alone, respectively.

Methods

Fifty patients with APS-3, 60 patients with T1DM and 40 patients with AH were included. Anthropometric, clinical and biochemical parameters were evaluated in all patients. Insulin requirement was calculated in patients with APS-3 and T1DM, while levothyroxine requirement was calculated in APS-3 and AH.

Results

Patients with APS-3 showed higher age (p = 0.001), age of onset of diabetes (p = 0.006) and TSH (p = 0.004) and lower total insulin as U/day (p < 0.001) and U/Kg (p = 0.001), long-acting insulin as U/day (p = 0.030) and U/kg (p = 0.038) and irisin (p = 0.002) compared to T1DM. Patients with APS-3 had higher waist circumference (p = 0.008), duration of thyroid disease (p = 0.020), levothyroxine total daily dose (p = 0.025) and mcg/kg (p = 0.006), triglycerides (p = 0.007) and VAI (p = 0.010) and lower age of onset of thyroid disease (p = 0.007) than AH.

At multivariate analysis, levothyroxine treatment and VAI were associated with insulin and levothyroxine requirement in APS-3, respectively. VAI was independently associated with insulin requirement in T1DM. Circulating irisin levels were independently associated with levothyroxine requirement in AH.

Conclusion

Patients with APS-3 show lower insulin requirement and higher levothyroxine requirement than T1DM and AH alone, respectively. Levothyroxine treatment and VAI affect insulin and levothyroxine requirement, respectively, in APS-3. In T1DM, adipose tissue dysfunction, indirectly expressed by high VAI, is associated with an increased insulin requirement, while circulating irisin levels influence the levothyroxine requirement in AH.
Adverse pathophysiological influence of early testosterone therapy on the testes of boys with higher grade sex chromosome aneuploidies (HGAs): a retrospective, cross-sectional study
Authors: Spaziani M. , Tarantino C. , Pozza C. , Anzuini A. , Panimolle F. , Papi G. , Gianfrilli D. , Lenzi A. , Radicioni A. F.
Published: October 2020

Purpose

Higher grade aneuploidies (HGAs) of the male sex chromosomes are a rare genetic group of pathologies caused by nondisjunction meiotic events. The aim of this study was to evaluate the impact of early androgenic therapy on the testicular secretory hormone profile, and the pathophysiological implications.

Patients and methods

In this cross-sectional study, 18 HGA subjects aged 6–8 years were recruited. They were divided into two groups, based on whether or not they had previously undergone testosterone therapy (group 1: 11 untreated subjects; group 2: 7 treated subjects). Serum FSH, LH, testosterone (T), inhibin B (INHB) and anti-Müllerian hormone (AMH) were determined, and auxological parameters were assessed. Five group 1 patients and four group 2 patients were treated with hCG (human chorionic gonadotropin) for inguinal cryptorchidism; their hormone profile and auxological parameters were assessed both pre- and post-hCG treatment.

Results

Group 1 subjects showed significantly higher testicular volume and higher levels of AMH and INHB (p < 0.0001). Subjects who had undergone hCG therapy showed a significantly higher testicular volume, penis length (respectively,p = 0.008 andp = 0.0005 for group 1 andp = 0.04 andp = 0.001 for group 2) and T (p = 0.005 for group 1 andp = 0.004 for group 2).

Conclusions

HGA patients undergoing early testosterone therapy show an earlier and persistent suppression of testicular secretory function. At this age, the testes are still responsive to stimulation with hCG. The selection of patients to be treated must be accompanied by a thorough clinical and hormonal evaluation.
Geomorphic and Sedimentary Effects of Modern Climate Change: Current and Anticipated Future Conditions in the Western United States
Authors: East Amy E. , Sankey Joel B.
Published: October 2020

Hydroclimatic changes associated with global warming over the past 50 years have been documented widely, but physical landscape responses are poorly understood thus far. Detecting sedimentary and geomorphic signals of modern climate change presents challenges owing to short record lengths, difficulty resolving signals in stochastic natural systems, influences of land use and tectonic activity, long‐lasting effects of individual extreme events, and variable connectivity in sediment‐routing systems. We review existing literature to investigate the nature and extent of sedimentary and geomorphic responses to modern climate change, focusing on the western United States, a region with generally high relief and high sediment yield likely to be sensitive to climatic forcing. Based on fundamental geomorphic theory and empirical evidence from other regions, we anticipate climate‐driven changes to slope stability, watershed sediment yields, fluvial morphology, and aeolian sediment mobilization in the western United States. We find evidence for recent climate‐driven changes to slope stability and increased aeolian dune and dust activity, whereas changes in sediment yields and fluvial morphology have been linked more commonly to nonclimatic drivers thus far. Detecting effects of climate change will require better understanding how landscape response scales with disturbance, how lag times and hysteresis operate within sedimentary systems, and how to distinguish the relative influence and feedbacks of superimposed disturbances. The ability to constrain geomorphic and sedimentary response to rapidly progressing climate change has widespread implications for human health and safety, infrastructure, water security, economics, and ecosystem resilience.
Rising Seas and Agriculture Created Wetlands Along the U.S. East Coast
Authors: Pinson Jerald
Published: October 2020

Most of the tidal marshes along the eastern coast of the United States formed within the past 6,000 years due to a combination of slowly rising seas and European colonization.
Oak Transpiration Drawn From the Weathered Bedrock Vadose Zone in the Summer Dry Season
Authors: Hahm W. J. , Rempe D. M. , Dralle D. N. , Dawson T. E. , Dietrich W. E.
Published: October 2020

The spatiotemporal dynamics of plant water sources are hidden and poorly understood. We document water source use of Quercus garryana growing in Northern California on a profile of approximately 50 cm of soil underlain by 2–4 m of weathered bedrock (sheared shale mélange) that completely saturates in winter, when the oaks lack leaves, and progressively dries over the summer. We determined oak water sources by combining observations of water stable isotope composition, vadose zone moisture and groundwater dynamics, and metrics of tree water status (potential) and use (sapflow). During the spring, oak xylem water is isotopically similar to the seasonal groundwater and shallow, evaporatively enriched soil moisture pools. However, as soils dry and the water table recedes to the permanently saturated, anoxic, low‐conductivity fresh bedrock boundary, Q. garryana shifts to using a water source with a depleted isotopic composition that matches residual moisture in the deep soil and underlying weathered bedrock vadose zone. Sapflow rates remain high as late‐summer predawn water potentials drop below −2.5 MPa. Neutron probe surveys reveal late‐summer rock moisture declines under the oaks in contrast to constant rock moisture levels under grass‐dominated areas. We therefore conclude that the oaks temporarily use seasonal groundwater when it occupies the weathered profile but otherwise use deep unsaturated zone moisture after seasonal groundwater recedes. The ample moisture, connected porosity, and oxygenated conditions of the weathered bedrock vadose zone make it a key tree water resource during the long summer dry season of the local Mediterranean climate.