bluuebunny/crossref_metadata_2025 huggingface dataset:
Effective entropy of quantum fields coupled with gravity
Authors: Dong Xi , Qi Xiao-Liang , Shangnan Zhou , Yang Zhenbin
Published: October 2020

Abstract

Entanglement entropy, or von Neumann entropy, quantifies the amount of uncertainty of a quantum state. For quantum fields in curved space, entanglement entropy of the quantum field theory degrees of freedom is well-defined for a fixed background geometry. In this paper, we propose a generalization of the quantum field theory entanglement entropy by including dynamical gravity. The generalized quantity named effective entropy, and its Renyi entropy generalizations, are defined by analytic continuation of a replica calculation. The replicated theory is defined as a gravitational path integral with multiple copies of the original boundary conditions, with a co-dimension-2 brane at the boundary of region we are studying. We discuss different approaches to define the region in a gauge invariant way, and show that the effective entropy satisfies the quantum extremal surface formula. When the quantum fields carry a significant amount of entanglement, the quantum extremal surface can have a topology transition, after which an entanglement island region appears. Our result generalizes the Hubeny-Rangamani-Takayanagi formula of holographic entropy (with quantum corrections) to general geometries without asymptotic AdS boundary, and provides a more solid framework for addressing problems such as the Page curve of evaporating black holes in asymptotic flat spacetime. We apply the formula to two example systems, a closed two-dimensional universe and a four-dimensional maximally extended Schwarzchild black hole. We discuss the analog of the effective entropy in random tensor network models, which provides more concrete understanding of quantum information properties in general dynamical geometries. We show that, in absence of a large boundary like in AdS space case, it is essential to introduce ancilla that couples to the original system, in order for correctly characterizing quantum states and correlation functions in the random tensor network. Using the superdensity operator formalism, we study the system with ancilla and show how quantum information in the entanglement island can be reconstructed in a state-dependent and observer-dependent map. We study the closed universe (without spatial boundary) case and discuss how it is related to open universe.
The persistence of the Chekanov–Eliashberg algebra
Authors: Dimitroglou Rizell Georgios , Sullivan Michael G.
Published: October 2020

We apply the barcodes of persistent homology theory to the c Chekanov–Eliashberg algebra of a Legendrian submanifold to deduce displacement energy bounds for arbitrary Legendrians. We do not require the full Chekanov–Eliashberg algebra to admit an augmentation as we linearize the algebra only below a certain action level. As an application we show that it is not possible to $$C^0$$

C
0

-approximate a stabilized Legendrian by a Legendrian that admits an augmentation.
Performance assessment of two motion management systems for frameless stereotactic radiosurgery
Authors: Wang Hao , Xu Zhiyong , Grantham Kevin , Zhou Yongkang , Cui Taoran , Zhang Yin , Liu Bo , Wang Xiao , Vergalasova Irina , Reyhan Meral , Weiner Joseph , Danish Shabbar F. , Yue Ning , Nie Ke
Published: October 2020

Background/Purpose

Frameless stereotactic radiosurgery (SRS) requires dedicated systems to monitor patient motion in order to avoid inaccurate radiation delivery due to involuntary shifts. The purpose of this study is to assess the accuracy and sensitivity of two distinct motion monitoring systems used for frameless SRS.

Methods

A surface image-guided system known as optical surface monitoring system (OSMS), and a fiducial marker-based system known as high definition motion management (HDMM) as part of the latest Gamma Knife Icon® were compared. A 3D printer-based cranial motion phantom was developed to evaluate the accuracy and sensitivity of these two systems in terms of: (1) the capability to recognize predefined shifts up to 3 cm, and (2) the capability to recognize predefined speeds up to 3 cm/s. The performance of OSMS, in terms of different reference surfaces, was also evaluated.

Results

Translational motion could be accurately detected by both systems, with an accuracy of 0.3 mm for displacement up to 1 cm, and 0.5 mm for larger displacements. The reference surface selection had an impact on OSMS performance, with flat surface resulting in less accuracy. HDMM was in general more sensitive when compared with OSMS in capturing the motion, due to its faster frame rate, but a delay in response was observed with faster speeds. Both systems were less sensitive in detection of superior-inferior motion when compared to lateral or vertical displacement directions.

Conclusion

Translational motion can be accurately and sensitively detected by OSMS and HDMM real-time monitoring systems. However, performance variations were observed along different motion directions, as well as amongst the selection of reference images. Caution is needed when using real-time monitoring systems for frameless SRS treatment.
Pelvic angioembolization: how urgently needed?
Authors: Devaney Giles Lawrence , King Kate Louise , Balogh Zsolt Janos
Published: October 2020

Purpose

Angioembolization (AE) has been questioned as first-line modality for hemorrhage control of pelvic fracture (PF)-associated bleeding due to its potential inconsistent timely availability. We aimed to describe the patterns of AE use with hemostatic resuscitation and hypothesized that time to AE improved during the study period.

Methods

A Level-1 trauma center’s prospective PF database was analyzed. All consecutive PFs referred to angiography between 01/01/2009 and 12/31/2018 were included. All suspected pelvic hemorrhage was managed with AE; pelvic packing was not performed. Demographics, injury/shock severity, 24-h transfusion data, time to AE and mortality were recorded. Data are presented as median (IQR).

Results

During the 10-year study period, 1270 PF patients were treated. Thirty-six (2.8%) [75% male, 49 (33;65) years, ISS 36 (24;43), base deficit 3.65 (5.9;0.6), transfusions 4(2;7)] had AE. The indication for AE was clinical suspicion (CS) of pelvic bleeding [CS 24(67%)] or arterial blush on CT [CT 12 (33%)]. Median time to AE was 141 min for CS, and 223 min for CT, with no change over the study period. Patients with CS had a higher ISS, worse base deficit, greater transfusion requirements and faster time to AE. Five patients (14%) died. There were no deaths attributed to exsanguination.

Conclusions

Time to AE did not improve. Patients referred from CT are physiologically different from CS and should be analyzed accordingly, with CS resulting in faster time to AE in sicker patients. Contemporary resuscitation challenges the need for hyperacute AE as no patients exsanguinated despite time to AE of more than 2 h.
Long-term effects of empagliflozin on excitation-contraction-coupling in human induced pluripotent stem cell cardiomyocytes
Authors: Pabel Steffen , Reetz Florian , Dybkova Nataliya , Shomroni Orr , Salinas Gabriela , Mustroph Julian , Hammer Karin P. , Hasenfuss Gerd , Hamdani Nazha , Maier Lars S. , Streckfuss-Bömeke Katrin , Sossalla Samuel
Published: October 2020

The SGLT2 inhibitor empagliflozin improved cardiovascular outcomes in patients with diabetes. As the cardiac mechanisms remain elusive, we investigated the long-term effects (up to 2 months) of empagliflozin on excitation-contraction (EC)-coupling in human cardiomyocytes derived from induced pluripotent stem cells (iPSC-CM) in a blinded manner. IPSC from 3 donors, differentiated into pure iPSC-CM (4 differentiations), were treated with a clinically relevant concentration of empagliflozin (0.5 μmol/l) or vehicle control. Treatment, data acquisition, and analysis were conducted externally blinded. Epifluorescence microscopy measurements in iPSC-CM showed that empagliflozin has neutral effects on Ca2+ transient amplitude, diastolic Ca2+ levels, Ca2+ transient kinetics, or sarcoplasmic Ca2+ load after 2 weeks or 8 weeks of treatment. Confocal microscopy determining possible effects on proarrhythmogenic diastolic Ca2+ release events showed that in iPSC-CM, Ca2+ spark frequency and leak was not altered after chronic treatment with empagliflozin. Finally, in patch-clamp experiments, empagliflozin did not change action potential duration, amplitude, or resting membrane potential compared with vehicle control after long-term treatment. Next-generation RNA sequencing (NGS) and mapped transcriptome profiles of iPSC-CMs untreated and treated with empagliflozin for 8 weeks showed no differentially expressed EC-coupling genes. In line with NGS data, Western blots indicate that empagliflozin has negligible effects on key EC-coupling proteins. In this blinded study, direct treatment of iPSC-CM with empagliflozin for a clinically relevant duration of 2 months did not influence cardiomyocyte EC-coupling and electrophysiology. Therefore, it is likely that other mechanisms independent of cardiomyocyte EC-coupling are responsible for the beneficial treatment effect of empagliflozin.

Key messages

This blinded study investigated the clinically relevant long-term effects (up to 2 months) of empagliflozin on cardiomyocyte excitation-contraction (EC)-coupling.

Human cardiomyocytes derived from induced pluripotent stem cells (iPSC-CM) were used to study a human model including a high repetition number of experiments.

Empagliflozin has neutral effects on cardiomyocyte Ca2+ transients, sarcoplasmic Ca2+ load, and diastolic sarcoplasmic Ca2+ leak.

In patch-clamp experiments, empagliflozin did not change the action potential.

Next-generation RNA sequencing, mapped transcriptome profiles, and Western blots of iPSC-CM untreated and treated with empagliflozin showed no differentially expressed EC-coupling candidates.
A workflow to build PBTK models for novel species
Authors: Schneckener Sebastian , Preuss Thomas G. , Kuepfer Lars , Witt Johannes
Published: October 2020

Physiology-based pharmacokinetic and toxicokinetic (PBPK/TK) models allow us to simulate the concentration of xenobiotica in the plasma and different tissues of an organism. PBPK/TK models are therefore routinely used in many fields of life sciences to simulate the physiological concentration of exogenous compounds in plasma and tissues. The application of PBTK models in ecotoxicology, however, is currently hampered by the limited availability of models for focal species. Here, we present a best practice workflow that describes how to build PBTK models for novel species. To this end, we extrapolated eight previously established rabbit models for several drugs to six additional mammalian species (human, beagle, rat, monkey, mouse, and minipig). We used established PBTK models for these species to account for the species-specific physiology. The parameter sensitivity in the resulting 56 PBTK models was systematically assessed to rank the relevance of the parameters on overall model performance. Interestingly, more than 80% of the 609 considered model parameters showed a negligible sensitivity throughout all models. Only approximately 5% of all parameters had a high sensitivity in at least one of the PBTK models. This approach allowed us to rank the relevance of the various parameters on overall model performance. We used this information to formulate a best practice guideline for the efficient development of PBTK models for novel animal species. We believe that the workflow proposed in this study will significantly support the development of PBTK models for new animal species in the future.
The zero length column technique to measure adsorption equilibrium and kinetics: lessons learnt from 30 years of experience
Authors: Brandani Stefano , Mangano Enzo
Published: October 2020

The zero length column technique has been developed over the past 30 years as a versatile experimental method to measure adsorption equilibrium and kinetics. In this review we discuss in detail the theory that forms the basis for the technique in order to understand how to design and operate efficiently a system. Experimental checks that should be performed to ensure the correct interpretation of the dynamic response are presented and examples are used to identify how to avoid major errors in determining diffusion time constants. The review concludes with an overview of all experimental studies available in the literature to date and a set of recommendations that should help improve the standard in the reported equilibrium and kinetic properties.
Building Projects on the Local Communities’ Planet: Studying Organizations’ Care-Giving Approaches
Authors: Derakhshan Roya
Published: October 2020

This study examines local communities’ lived experiences and organizations’ care-giving processes regarding four oil and gas projects deployed in three countries. Analyzing the empirical data through the lens of ethics of care reveals that, together with mature justice, the inclination to care conceived at the focal organization creates an ethical culture encouraging caring activities by individuals at the local level. Through close communications with communities, project decision makers at the local level recognize the demanded care of local communities and develop organizations’ caring capacity. The empirical analysis revealed that the care-giving process can also be influenced by the power dynamics of the network of stakeholders. This research emphasizes on the success of a bottom-up approach in caring for local communities, and sheds light on the capability of large organizations in giving care to their distal stakeholders by adopting this approach. Furthermore, it indicates that justice and care both have some useful characteristics and are complementary but, most importantly, are socially constructed and not mutually exclusive.
Exploring the Perceptions of the Ageing Experience in Singaporean Older Adults: a Qualitative Study
Authors: Shiraz F. , Hildon Z. L. J. , Vrijhoef H. J. M.
Published: October 2020

Understanding older adults perceptions of health and adaptation processes to ageing can allow for more culturally aligned services and better targeted care. The aim of this exploratory qualitative study was to examine older adults perceptions of physical, psychological and social health and further understand the processes of adaptation and self-management of these health perceptions. Semi-structured in depth interviews (IDI) were conducted with ethnically diverse older adults in Singapore, aged 60 and above. Participants were asked open ended questions about their physical health, psychological health and their current social health and relationships. They were also asked methods of adaptation to these age related changes. In total, forty participants were interviewed. A thematic analysis identified five main themes when exploring perceptions of physical, psychological and social health. These included; 1) Slowing down 2) Relationship harmony 3) Financial harmony 4) Social connectedness and 5) Eating together. Adaptation and self-management of these health perceptions included six additional themes; 1) Keep moving 2) Keep learning; where continued self-determination and resilience was a key method in adapting to negative thoughts about declining physical health 3) Adopting avoidant coping behaviours 4) ‘It feels good to do good’; where finding meaning in life was to help others 5) ‘Power of Prayer’; which highlighted how older adults relegated responsibilities to a higher spiritual power 6) Social participation; which included engaging in community and religious social activities that all contributed to self-management of older adults psychological health and social health. In conclusion, our study highlighted specific cultural nuances in older adults perceptions of health, particularly psychological and social health. These findings can help develop more targeted intervention programmes and better methods of measuring older adults health, which can assist with the global ageing phenomena.
Effective Recruitment Strategies for a Sickle Cell Patient Registry Across Sites from the Sickle Cell Disease Implementation Consortium (SCDIC)
Authors: Masese Rita V. , DeMartino Terri , Bonnabeau Emily , Burns Ebony N. , Preiss Liliana , Varughese Taniya , Nocek Judith M. , Lasley Patricia , Chen Yumei , Davila Caroline , Nwosu Chinonyelum , Scott Samantha , Bowman Latanya , Gordon Lauren , Clesca Cindy , Peters-Lawrence Marlene , Melvin Cathy , Shah Nirmish , Tanabe Paula ,   SCD Implementation Consortium
Published: October 2020

Sickle cell disease (SCD) is a genetic disorder predominantly affecting people of African descent and is associated with significant morbidity and mortality. To improve SCD outcomes, the National Heart Lung and Blood Institute funded eight centers to participate in the SCD Implementation Consortium. Sites were required to each recruit 300 individuals with SCD, over 20 months. We aim to describe recruitment strategies and challenges encountered. Participants aged 15–45 years with confirmed diagnosis of SCD were eligible. Descriptive statistics were used to analyze the effectiveness of each recruitment strategy. A total of 2432 participants were recruited. Majority (95.3%) were African American. Successful strategies were recruitment from clinics (68.1%) and affiliated sites (15.6%). Recruitment at community events, emergency departments and pain centers had the lowest yield. Challenges included saturation of strategies and time constraints. Effective recruitment of participants in multi-site studies requires multiple strategies to achieve adequate sample sizes.
Betreuungsbedürfnisse von Patienten mit Übergewicht und Adipositas in der Hausarztpraxis – Ergebnisse einer Interviewstudie
Authors: Wangler Julian , Jansky Michael
Published: October 2020

Hintergrund

Hausärzten wird große Bedeutung zugeschrieben, wenn es darum geht, übergewichtige und adipöse Patienten zu beraten und zu managen. Auf Basis eines langfristigen Arzt-Patient-Verhältnisses bieten sich Allgemeinmedizinern vielfältige Handlungsmöglichkeiten, um Übergewichtsproblematiken zu behandeln.

Ziel der Arbeit

Die Studie geht der Frage nach, welche Erfahrungen übergewichtige und Adipositaspatienten mit der hausärztlichen Betreuung gemacht haben und welche Bedürfnisse sie an Hausärzte herantragen. Mithilfe der Ergebnisse werden Ansatzpunkte für eine Optimierung des primärärztlichen Settings bestimmt.

Material und Methoden

Über 12 Online-Gesundheitsforen wurden insgesamt 16 von Übergewicht betroffene Personen rekrutiert, mit denen zwischen September 2019 und April 2020 qualitative Interviews geführt wurden.

Ergebnisse

Die Interviewten sehen den Hausarzt als zentralen Ansprechpartner zur Beratung und Unterstützung bei Gewichtsproblemen an. Der Rat des Hausarztes wird mit einer erhöhten Bereitschaft verbunden, sich mit der Verringerung des eigenen Gewichts zu befassen. Dennoch zeigen sich aus Sicht der Befragten verbreitete Schwachpunkte: 1) beiläufige oder verzögerte Feststellung von Übergewicht, 2) Ausbleiben einer kontinuierlichen Gewichtsberatung, 3) keine Vereinbarung von konkreten Zielen, 4) fehlende Verweise auf Hilfsangebote, 5) unsensible Gesprächsführung. Nur ein Teil der Interviewten, die ihr Gewicht nachhaltig verringern konnten, führt diese Erfolge auf die hausärztliche Unterstützung zurück.

Diskussion

Hausärzte sollten bestärkt werden, Übergewicht konsequent zu thematisieren. Zudem sollten konkrete, realistische Empfehlungen zur Gewichtsabnahme formuliert werden. Dabei ist eine kontinuierliche, motivierende Gesprächsführung entscheidend. Anzuregen wäre zudem eine fokussierte Ernährungs- und Bewegungsberatung in der Hausarztpraxis. Hausärzte sollten Patienten je nach Bedarf in ein Netzwerk weiterer Hilfen einbinden. Die Entwicklung hausarztkonformer Versorgungsstrukturen zum Adipositasmanagement sollte vorangetrieben werden.
Legitimacy challenges to the liberal world order: Evidence from United Nations speeches, 1970–2018
Authors: Kentikelenis Alexander , Voeten Erik
Published: October 2020

The liberal international economic order has been facing high-profile legitimacy challenges in recent years. This article puts these challenges in historical context through a systematic analysis of rhetorical challenges towards both the order per se and specific global economic institutions. Drawing on Albert Hirschman’s classic typology of exit, voice and loyalty, we coded leaders’ speeches in the General Debate at the UN General Assembly between 1970 and 2018 as articulating intentions to abandon elements of the order, challenges or calls for reform, unequivocal support, or factual mentions of cooperation. Surprisingly, we find that explicit criticisms towards the liberal order are at an all-time low and that exit threats remain rare. An analysis of the historical evolution of criticisms to global economic institutions reveals a move away from the Cold War insider-outsider conflict towards insider contestation. For example, we find that as countries’ economies become more open, their leaders expressed more support for global economic institutions during the Cold War but less support since. Finally, we demonstrate consistency between the public policy positions leaders announce in UNGA General Debate speeches and their government positions on consequential reform debates on debt relief.
Establishment of long-term ostracod epidermal culture
Authors: Morgan Siân R. , Paletto Laura , Rumney Benjamin , Malik Farhana T. , White Nick , Lewis Philip N. , Parker Andrew R. , Holden Simon , Meek Keith M. , Albon Julie
Published: October 2020

Primary crustacean cell culture was introduced in the 1960s, but to date limited cell lines have been established. Skogsbergia lerneri is a myodocopid ostracod, which has a body enclosed within a thin, durable, transparent bivalved carapace, through which the eye can see. The epidermal layer lines the inner surface of the carapace and is responsible for carapace synthesis. The purpose of the present study was to develop an in vitro epidermal tissue and cell culture method for S. lerneri. First, an optimal environment for the viability of this epidermal tissue was ascertained, while maintaining its cell proliferative capacity. Next, a microdissection technique to remove the epidermal layer for explant culture was established and finally, a cell dissociation method for epidermal cell culture was determined. Maintenance of sterility, cell viability and proliferation were key throughout these processes. This novel approach for viable S. lerneri epidermal tissue and cell culture augments our understanding of crustacean cell biology and the complex biosynthesis of the ostracod carapace. In addition, these techniques have great potential in the fields of biomaterial manufacture, the military and fisheries, for example, in vitro toxicity testing.
Synthesis and Characterization of 12CaO·7Al2O3 Slags: The Effects of Impurities and Atmospheres on the Phase Relations
Authors: Azof Fabian Imanasa , Tang Kai , You Jinglin , Safarian Jafar
Published: October 2020

Synthesis of crystalline slags of 12CaO·7Al2O3 phase from the corresponding melt compositions in different atmospheric conditions and different purities is investigated. Observations using a thermogravimetry coupled with differential thermal analysis showed that the dehydration of a zeolitic 12CaO·7Al2O3 phase occur at 770 °C to 1390 °C before it congruently melts at 1450 °C. The X-ray diffraction pattern of the slag showed that a single 12CaO·7Al2O3 phase is produced from a mixture, which has small SiO2 impurity with a 49:51 mass ratio of CaO to Al2O3. A scanning electron microscope and electron probe micro-analyzer showed that a minor Ca-Al-Si-O-containing phase is in equilibrium with a grain-less 12CaO·7Al2O3 phase. Moreover, 12CaO·7Al2O3 is unstable at room temperature when the high-purity molten slag is solidified under oxidizing conditions contained in an alumina crucible. On the other hand, a high-temperature in-situ Raman spectroscopy of a slag that was made of a higher purity CaO-Al2O3 mixture showed that 5CaO·3Al2O3 phase is an unstable/intermediate phase in the the CaO-Al2O3 system, which is decomposed to 12CaO·7Al2O3 above 1100 °C upon heating in oxidizing conditions. It was found that 5CaO·3Al2O3 is present at room temperature when the 12CaO·7Al2O3 dissociates to a mixture of 5CaO·3Al2O3, 3CaO·Al2O3, and CaO·Al2O3 phases during the cooling of the slag at 1180 °C ± 20 °C in reducing atmosphere. It is proposed that low concentrations of Si stabilize 12CaO·7Al2O3 (mayenite), in which Si is a solid solution in its lattice, which is named Si-mayenite. Regarding the calculated CaO-Al2O3-SiO2 diagram in this study, this phase may contain a maximum of 4.7 wt pct SiO2, which depends on the total SiO2 in the system and the Ca/Al ratio.
Radial head fractures in young, active patients
Authors: Larsen Christopher G. , Fitzgerald Michael J. , Greenberg Andrew S.
Published: October 2020

The radial head is an important stabilizer of the elbow joint. Radial head fractures are commonly associated with additional injuries to the ligamentous structures of the elbow and can significantly compromise elbow stability. Young patients with radial head fractures are more likely to be male and present after a high-energy mechanism of injury. While not perfect, the Mason classification is the most commonly used classification system and can help to guide the management of radial head fractures. Type I fractures are nondisplaced or minimally displaced (less than 2 mm) and are treated nonoperatively with early mobilization. Type II fractures, which are displaced 2–5 mm, can be treated nonoperatively or with open reduction and internal fixation (ORIF). Type III fractures are comminuted and are most often treated with ORIF or with radial head arthroplasty (RHA). Treatment of fractures with an associated elbow dislocation (Mason type IV) is also with ORIF or RHA depending on the degree of comminution. For all of these injuries, assessment and treatment of associated ligamentous injuries are necessary in conjunction with treatment of the bony injury. Despite a significant body of literature available on radial head fractures, there is controversy regarding the optimal management of type II, III, and IV fractures, especially in young, active patients. Common complications following radial head fractures include stiffness, instability, and posttraumatic osteoarthritis; as such, these injuries can lead to significant disability in young, active patients if not managed appropriately.
Predictors of avascular necrosis of the trochlea after pediatric supracondylar humerus fractures
Authors: Ott N. , Hackl M. , Leschinger T. , Wegmann K. , Müller L. P.
Published: October 2020

Background

Supracondylar fractures of the humerus are the most common type of elbow fractures in childhood. Due to the potential risk of severe complications, trauma surgeons should address them with caution. Avascular necrosis of the trochlea presents a rare but oftentimes disabling complication and should not be underestimated. The aim of the present study was to identify possible predictors of avascular necrosis of the trochlea following pediatric supracondylar humerus fractures.

Methods

We reviewed the available body of literature reporting clinical outcomes, complications, and possible predictors of avascular necrosis of the trochlea after supracondylar humerus fractures in childhood. Data on patient age, sex, the affected side, fracture classification, treatment, the number of K‑wires, time to surgery, complications, and the time from injury to diagnosis of avascular necrosis were obtained. This study was performed according to the PRISMA guidelines.

Results

Eight clinical studies were included, comprising 30 patients with avascular necrosis after supracondylar fractures in childhood. The mean age at the time of injury was 5 years (min. 2; max. 10; SD: 2.8 years). In all, 18 patients (60.0%) were male, 11 (36.7%) were female, and one was unknown (3.3%). Five patients (16.7%) had a Gartland type I, three (10.0%) a type II, and 22 (73.3%) a type III fracture of the distal humerus. Six patients (20.0%) were treated conservatively, whereas 24 patients (80.0%) underwent operative treatment. The mean time from injury to diagnosis of avascular necrosis was 33 months (min. 4; max. 84; SD: 24.5 months).

Conclusion

The available literature on avascular necrosis of the trochlea following pediatric supracondylar humerus fractures is limited. While it can occur in any supracondylar fracture, fracture displacement may be considered a risk factor.
Localized Non-melanoma Skin Cancer: Risk Factors of Post-surgical Relapse and Role of Postoperative Radiotherapy
Authors: Caparrotti Francesca , Troussier Idriss , Ali Abdirahman , Zilli Thomas
Published: October 2020

Opinion statement

The mainstay treatment of localized non-melanoma skin cancer (NMSC) is surgical excision or Mohs surgery. However, approximately 5% of patients with NMSC harbor high-risk clinicopathologic features for loco-regional recurrence, and distant metastasis. Prognostic factors such as close or positive margins, tumor size ≥ 2 cm, poor tumor differentiation, perineural invasion, depth of invasion, and immunosuppression have all been associated with increased loco-regional recurrence and impaired survival rates. In these patients more aggressive treatments are needed and radiotherapy (RT) is often discussed as adjuvant therapy after surgical resection. Due to the retrospective setting and the heterogeneity of the available studies, indications for adjuvant RT in patients with localized resected NMSC harboring high-risk features remain debated. Studies highlighting the limitations of our current understanding of the independent prognosis of each risk factor are needed to better define the role of adjuvant RT on outcome of localized NMSC and standardize its indications in the clinical setting.
Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes?
Authors: Harreiter Jürgen , Fadl Helena , Kautzky-Willer Alexandra , Simmons David
Published: October 2020

Purpose of Review

This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes.

Recent Findings

In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher “within-gender” RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities.

The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women.
Hypothetical Pathway for Formation of Cholesterol Microcrystals Initiating the Atherosclerotic Process
Authors: Subczynski Witold K. , Pasenkiewicz-Gierula Marta
Published: October 2020

Major factors leading to the development of atherosclerosis are a high cholesterol (Chol) level in the blood and oxidative stress. Both promote the formation of Chol microcrystals in blood vessel walls. Deposition of Chol microcrystals in arterial intima causes inflammation, which initiates and accompanies the atherosclerotic process in all its phases. One of the possible sources of Chol in the blood vessel walls is oxidized low-density lipoproteins—this atherosclerotic plaque formation pathway has already been described in the literature. Here, we hypothesize that initiation of the atherosclerotic process may involve Chol domains in the plasma membranes of arterial cells. Increased Chol content and the presence of polyunsaturated phospholipids in these membranes together with oxidative stress (phospholipid peroxidation) may lead to the formation of pure Chol bilayer domains that, with further peroxidation and increased Chol content, may collapse in the form of Chol seed crystals. Independent of their origin, Chol microcrystals activate inflammasomes, thereby stimulate immune responses, and initiate inflammation that may lead to the development of atherosclerosis. This new, hypothetical pathway has not yet been investigated in depth; however, data from the literature and our own results support its feasibility.
1HN, 13C, and 15N resonance assignments of the Clostridioides difficile receptor binding domain 2 (CDTb, residues 757–876)
Authors: Cook Mary E. , Varney Kristen M. , Godoy-Ruiz Raquel , Weber David J.
Published: October 2020

Clostridioides difficile is a bacterial pathogen responsible for the majority of nosocomial infections in the developed world. C. difficile infection (CDI) is difficult to treat in many cases because hypervirulent strains have evolved that contain a third toxin, termed the C. difficile toxin (CDT), in addition to the two enterotoxins TcdA and TcdB. CDT is a binary toxin comprised of an enzymatic, ADP-ribosyltransferase (ART) toxin component, CDTa, and a pore-forming or delivery subunit, CDTb. In the absence of CDTa, CDTb assembles into two distinct di-heptameric states, a symmetric and an asymmetric form with both states having two surface-accessible host cell receptor-binding domains, termed RBD1 and RBD2. RBD1 has a unique amino acid sequence, when aligned to other well-studied binary toxins (i.e., anthrax), and it contains a novel Ca2+-binding site important for CDTb stability. The other receptor binding domain, RBD2, is critically important for CDT toxicity, and a domain such as this is missing altogether in other binary toxins and shows further that CDT is unique when compared to other binary toxins. In this study, the 1H, 13C, and 15N backbone and sidechain resonances of the 120 amino acid RBD2 domain of CDTb (residues 757–876) were assigned sequence-specifically and provide a framework for future NMR-based drug discovery studies directed towards targeting the most virulent strains of CDI.
Multidimensional Child Poverty in Ghana: Measurements, Determinants, and Inequalities
Authors: Agyire-Tettey Frank , Asuman Derek , Ackah Charles Godfred , Tsiboe-Darko Antoinette
Published: October 2020

Early childhood deprivations and inequalities have social and economic implications in adulthood and thus, their elimination is essential for child development. However, child-level estimates of poverty are rare in low income countries. Using data from two recent rounds of the Ghana Demographic and Health Survey, we measure the extent and sources of childhood deprivations in Ghana and examine subgroup differentials in child poverty. In addition, we examine the child quality-quantity by estimating the causal relationship between number of children and child poverty. Finally, we assess the sources of rural-urban inequalities in child poverty. We find that despite declining incidence and intensity of multidimensional child poverty, significant subgroup differentials persist in Ghana. The findings of the paper reveal that living standards is the main contributor to multidimensional poverty in early childhood in Ghana. Our findings also confirm a significant causal relationship between child quality and quantity in Ghana, there exist a positive relationship between the number of children and the intensity of child poverty in Ghana. Finally, we find that rural-urban inequalities in child multidimensional poverty in Ghana are attributable to differences in observed maternal and household characteristics between rural and urban areas. The persistence of subgroup disparities in child poverty may be detrimental to achieving equitable and inclusive growth in the country. There is the need for considerations of equity, fairness and social justice in the distribution and development of social services and economic infrastructure to ensure even distribution of social and economic opportunities and promote social mobility across groups.
Degenerate Elastic Networks
Authors: Del Nin Giacomo , Pluda Alessandra , Pozzetta Marco
Published: October 2020

We minimize a linear combination of the length and the $$L^2$$

L
2

-norm of the curvature among networks in $$\mathbb {R}^d$$

R

d

belonging to a given class determined by the number of curves, the order of the junctions, and the angles between curves at the junctions. Since this class lacks compactness, we characterize the set of limits of sequences of networks bounded in energy, providing an explicit representation of the relaxed problem. This is expressed in terms of the new notion of degenerate elastic networks that, rather surprisingly, involves only the properties of the given class, without reference to the curvature. In the case of $$d=2$$

d
=
2

we also give an equivalent description of degenerate elastic networks by means of a combinatorial definition easy to validate by a finite algorithm. Moreover we provide examples, counterexamples, and additional results that motivate our study and show the sharpness of our characterization.
Lipid-rich Plaques Detected by Near-infrared Spectroscopy Are More Frequently Exposed to High Shear Stress
Authors: Hartman Eline M. J. , De Nisco Giuseppe , Kok Annette M. , Hoogendoorn Ayla , Coenen Adriaan , Mastik Frits , Korteland Suze-Anne , Nieman Koen , Gijsen Frank J. H. , van der Steen Anton F. W. , Daemen Joost , Wentzel Jolanda J.
Published: October 2020

High wall shear stress (WSS) and near-infrared spectroscopy (NIRS) detected lipid-rich plaque (LRP) are both known to be associated with plaque destabilization and future adverse cardiovascular events. However, knowledge of spatial co-localization of LRP and high WSS is lacking. This study investigated the co-localization of LRP based on NIRS and high WSS. Fifty-three patients presenting acute coronary syndrome underwent NIRS-intravascular-ultrasound (NIRS-IVUS) imaging of a non-culprit coronary artery. WSS was obtained using WSS profiling in 3D-reconstructions of the coronary arteries based on fusion of IVUS-segmented lumen and CT-derived 3D-centerline. Thirty-eight vessels were available for final analysis and divided into 0.5 mm/45° sectors. LRP sectors, as identified by NIRS, were more often colocalized with high WSS than sectors without LRP. Moreover, there was a dose-dependent relationship between lipid content and high WSS exposure. This study is a first step in understanding the evolution of LRPs to vulnerable plaques.
Appendiceal cancer leading to intussusception detected incidentally during follow-up for Peutz–Jeghers syndrome
Authors: Kurihara Kazuhiro , Suganuma Takanori
Published: October 2020

Peutz–Jeghers syndrome is an autosomal dominant disorder characterized by hamartomatous polyposis, pigmentation, and malignant tumors. We report a case of ileocecal carcinoma that was incidentally detected during follow-up for Peutz–Jeghers syndrome. A 39-year-old man with solitary Peutz–Jeghers syndrome had undergone three abdominal surgeries. He had been followed up via upper and lower gastrointestinal endoscopy and small intestinal endoscopy. In the endoscopic examination of the lower gastrointestinal tract, a 35 mm large, bumpy, elevated lesion was observed in the cecum. This lesion was not observed 9 months earlier during lower endoscopy. Biopsy of the specimen confirmed tubulovillous adenoma and carcinoma. This lesion was judged to be an indication for operation, and we performed ileocecectomy + D3 lymph node dissection. From the excised specimen, poorly differentiated carcinoma and adenoma components in contact with Peutz–Jeghers-type polyps in the appendix were recognized. A review of the computed tomography image obtained 2 years ago confirmed appendiceal swelling. We suspect that the ileocecal carcinoma in the appendix may have rapidly developed within the 9 months, and was incidentally detected on lower endoscopic examination during follow-up. For the prevention of appendicular tumorigenesis, prophylactic appendectomy may be considered in certain cases during follow-up for Peutz–Jeghers syndrome.
Wetland Vegetation Response to Groundwater Pumping and Hydrologic Recovery
Authors: Bartholomew Megan K. , Anderson Christopher J. , Berkowitz Jacob F.
Published: October 2020

An investigation of wetland vegetation response to groundwater alteration was conducted at the J.B. Starkey Wilderness Park, a large municipal wellfield in the area of west Florida, USA. Decades of historic groundwater withdrawal had created a gradient of impacted wetlands on the wellfield, after which time the groundwater pumping rates were reduced. Nineteen cypress dome wetlands were grouped, based on their hydrologic histories, as either most-altered (least inundation), marginally-altered (intermediate inundation), or least-altered (near-normal inundation). Annual species–level monitoring data were used to evaluate understory plant community response to the hydrologic recovery that resulted from reduced groundwater pumping. Species richness, cover, prevalence index (PI), and species importance percentages were assessed during pre- (2005–2007) and post- (2012–2014) hydrologic recovery periods. The vegetation in marginally- and most-altered wetlands responded to hydrologic recovery with increased species richness and lower PI values (i.e., greater hydrophytic character). However, species importance percentages indicated greater variation in the recovery of most-altered wetlands, where species composition often remained different from least-altered wetlands. Although reductions in groundwater pumping caused sufficient passive hydrologic recovery to elicit a vegetation response, further reductions and/or more time may be needed before the vegetation of some altered wetlands can become comparable to that of least-impacted wetlands.
The Sense of Effort: a Cost-Benefit Theory of the Phenomenology of Mental Effort
Authors: Székely Marcell , Michael John
Published: October 2020

In the current paper, we articulate a theory to explain the phenomenology of mental effort. The theory provides a working definition of mental effort, explains in what sense mental effort is a limited resource, and specifies the factors that determine whether or not mental effort is experienced as aversive. The core of our theory is the conjecture that the sense of effort is the output of a cost-benefit analysis. This cost-benefit analysis employs heuristics to weigh the current and anticipated costs of mental effort for a particular activity against the anticipated benefits. This provides a basis for spelling out testable predictions to structure future research on the phenomenology of mental effort.
A consumer-driven bioeconomy in housing? Combining consumption style with students' perceptions of the use of wood in multi-storey buildings
Authors: Kylkilahti Eliisa , Berghäll Sami , Autio Minna , Nurminen Jonne , Toivonen Ritva , Lähtinen Katja , Vihemäki Heini , Franzini Florencia , Toppinen Anne
Published: October 2020

Consumer acceptance of new bio-based products plays a key role in the envisioned transition towards a forest-based bioeconomy. Multi-storey wooden buildings (MSWB) exemplify a modern, bio-based business opportunity for enacting low-carbon urban housing. However, there is limited knowledge about the differing perceptions consumers hold regarding wood as an urban building material. To fill this gap, this study explores Finnish students’ perceptions of MSWB relative to their familiarity with wooden residential buildings, and then connects these perceptions to ‘consumption styles.’ Data were collected in the Helsinki metropolitan area via an online questionnaire (n = 531). The results indicate that the aesthetic appearance of MSWB are appreciated most by frugal and responsible consumers, whereas the comfort, environmental friendliness, and longevity of MSWB are important to consumers who identify themselves as ‘thoughtful spenders.’ The study suggests that both environmental and hedonic young consumers already familiar with the use of wood in housing contribute to a successful bioeconomy in the urban context.
Virtually Walking in a Patient’s Shoes—the Path to Empathy?
Authors: Elzie Carrie A. , Shaia Jacqueline
Published: October 2020

Empathy is the basis of a patient-physician relationship; however, this is being lost by students throughout medical training. Immersive virtual reality that allows individuals to viscerally experience anything from another person’s point of view has the potential to reverse the erosion of empathy and improve clinical practices.
Contemporary Virtue Ethics
Authors: Snow Nancy E.
Published: October 2020

This Element provides an overview of the central components of recent work in virtue ethics. The first section explores central themes in neo-Aristotelian virtue ethics, while the second turns the discussion to major alternative theoretical perspectives. The third section focuses on two challenges to virtue ethics. The first challenge is the self-centeredness or egoism objection, which is the notion that certain kinds of virtue ethics are inadequate because they advocate a focus on the person's own virtue and flourishing at the expense of, or at least without due regard for, the concerns of others. The second is situationist challenges to the ideas that there are indeed virtues and that personality is integrated enough to support virtues.
Port Cities of the Eastern Mediterranean
Authors: Fuhrmann Malte
Published: October 2020

Eastern Mediterranean port cities, such as Constantinople, Smyrna, and Salonica, have long been sites of fascination. Known for their vibrant and diverse populations, the dynamism of their economic and cultural exchanges, and their form of relatively peaceful co-existence in a turbulent age, many would label them as models of cosmopolitanism. In this study, Malte Fuhrmann examines changes in the histories of space, consumption, and identities in the nineteenth and early twentieth century while the Mediterranean became a zone of influence for European powers. Giving voice to the port cities' forgotten inhabitants, Fuhrmann explores how their urban populations adapted to European practices, how entertainment became a marker of a Europeanized way of life, and consuming beer celebrated innovation, cosmopolitanism and mixed gender sociability. At the same time, these adaptations to a European way of life were modified according to local needs, as was the case for the new quays, streets, and buildings. Revisiting leisure practises as well as the formation of class, gender, and national identities, Fuhrmann offers an alternative view on the relationship between the Islamic World and Europe.
Mechanical properties of UN-5100 envelope material for stratospheric airship
Authors: Xie W.-C. , Wang X.-L. , Duan D.-P. , Tang J.-W. , Wei Y.
Published: October 2020

Stratospheric airships are promising aircraft, usually designed as a non-rigid airship. As an essential part of the non-rigid airship, the envelope plays a significant role in maintaining its shape and bearing the external force load. Generally, the envelope material of a flexible airship consists of plain-weave fabric, composed of warp and weft fibre yarn. At present, biaxial tensile experiments are the primary method used to study the stress–strain characteristics of such flexible airship materials. In this work, biaxial tensile testing of UN-5100 material was carried out. The strain on the material under unusual stress and the stress ratio were obtained using Digital Image Correlation (DIC) technology. Also, the stress–strain curve was corrected by polynomial fitting. The slope of the stress–strain curve at different points, the Membrane Structures Association of Japan (MSAJ) standard and the Radial Basis Function (RBF) model were compared to identify the stress–strain characteristics of the materials. Some conclusions on the mechanical properties of the flexible airship material can be drawn and will play a significant role in the design of such envelopes.