bluuebunny/crossref_metadata_2025 huggingface dataset:
Aktuelle Entwicklungen in der Ernährungstherapie von Intensivpatienten
Authors: Koch Alexander , Bündgens Lukas , Herbers Ulf , Trautwein Christian , Tacke Frank
Published: December 2018

Was ist neu?

Identifikation von Intensivpatienten mit hohem Risiko einer Mangelernährung Mehr als 50 % der Intensivpatienten weisen bereits bei Aufnahme eine unspezifische Mangelernährung auf, jeder 10. Patient eine Protein-Energie-Mangelernährung. Bei lediglich ⅓ der Intensivpatienten ist keine Mangelernährung nachweisbar. Die Sterblichkeit von Intensivpatienten mit unspezifischer und/oder Protein-Energie-Mangelernährung ist erhöht. Zur Identifikation dieser Risikopatienten sind klinische Scores wie der NRS 2002 etabliert.

Ernährungstherapie kritisch kranker Patienten Zur Ernährungstherapie kritisch kranker Patienten gibt es neue evidenzbasierte europäische (ESPEN) und deutsche Leitlinien (DGEM).

Energiebedarf Die indirekte Kalorimetrie ist weiterhin der Goldstandard zur Bestimmung des Energiebedarfs. Ist eine Kalorimetrie nicht verfügbar, sollte im klinischen Alltag der Energiebedarf in der Akutphase mit 24 kcal/kg KG/d (DGEM-Leitlinie) bzw. 20 – 25 kcal/kg KG/d (ESPEN-Leitlinie) bei nicht adipösen Patienten (BMI < 30 kg/m2) abgeschätzt werden. Bei adipösen Patienten mit einem BMI von 30 – 50 kg/m2 sollte ein Energieziel von 11 – 14 kcal/kg KG/d (tatsächliches Körpergewicht) und bei Patienten mit einem BMI > 50 kg/m2 eines von 22 – 25 kcal/kg (ideales Körpergewicht) erreicht werden.

Proteinbedarf Der Proteinbedarf kritisch kranker Patienten liegt bei 1,2 – 1,3 g/kg KG/d tatsächliches aktuelles Körpergewicht. In der frühen Akutphase (Tag 1 – 3) sollte die Ernährung mit 75 % des Proteinziels begonnen und bis zum Ende dieser Phase auf 100 % gesteigert werden, um eine prognostisch ungünstige hyperkalorische Ernährung in der Akutphase zu vermeiden.

Start der Ernährungstherapie: wann und wie? Die Ernährungstherapie von Intensivpatienten soll innerhalb von 24 – 48 h nach Aufnahme in Form einer frühen enteralen Ernährung initiiert werden.

Zeitpunkt des Erreichens des kalorischen Ziels In zwei großen prospektiven, randomisierten, multizentrischen klinischen Studien (CALORIE und NUTRIREA-2) wurde gezeigt, dass parenterale und enterale Ernährung bei kritisch kranken Patienten in den wichtigen klinischen Endpunkten vergleichbar sind. Eine supplementierende parenterale Ernährung kann in der Akutphase sinnvoll sein, falls das angestrebte (hypokalorische) Energieziel mit enteraler Ernährung allein nicht zu erreichen ist, eine prognostisch ungünstige hyperkalorische Ernährung muss jedoch vermieden werden.

Probiotika Die routinemäßige Anwendung von Probiotika in der Intensivmedizin wird nicht empfohlen.

Gastrale oder post-pylorische Ernährung? Standardapplikationsweg einer enteralen Ernährung sind gastrale Sonden.
Simvastatin-induzierte Myopathie nach Dosiserhöhung
Authors: Kandzia Imke , Kowar Michael , Frackowiak Monika , Jacobs Andreas
Published: December 2018

Anamnese und klinischer Befund Wir berichten von einem 86-jährigen Patienten, der aufgrund einer zunehmenden Schwäche des rechten Beines aufgenommen wurde.

Untersuchungen und Diagnose Laborchemisch zeigten sich erhöhte Blutspiegel von Kreatinkinase und Kreatinin und im EMG konnte zusätzlich eine pseudomonotone Entladung im Sinne einer neuromuskulären Schädigung nachgewiesen werden. Da anamnestisch eine Erhöhung der Statindosis auf 80 mg täglich vor ca. 6 Monaten zu eruieren war, wurde die Diagnose einer Simvastatin-induzierten Myopathie mit Rhabdomyolyse gestellt.

Therapie und Verlauf Nach Absetzen der Statin-Therapie und unter Flüssigkeitssubstitution zeigten sich sowohl die Laborwerte als auch die klinische Symptomatik deutlich rückläufig.

Folgerung Bei unklarer neurologischer Symptomatik unter Statin-Therapie sollte an eine Statin-induzierte Myopathie gedacht und ggf. die Therapie beendet werden.
Synthesis of Conformationally Locked and C-Linked Analogues of Imidazole-Based Ketene Dithioacetal Fungicides
Authors: Lamberth Clemens , Gagnepain Julien , Jeanmart Stephane , Bonvalot Damien , Jacob Olivier
Published: December 2018

First examples with the unknown tricyclic 4,8b-dihydro-3aH-indeno[1,2-d][1,3]dithiole ring system have been prepared. Also, imidazoles linked in ring position 5 to a ketene dithioacetal and 1,3-dithiane derivatives with an exocyclic cyano- and imidazole-substituted C–C double bond are completely new. All these compounds are either conformationally locked, C-linked or six-ring analogues of the antifungal agent luliconazole. Synthesis and fungicidal activity of these sterol biosynthesis inhibitors are reported.
Using the Probability of Cesarean from a Validated Cesarean Prediction Calculator to Predict Labor Length and Morbidity
Authors: Hamm Rebecca , Downes Katheryne , Srinivas Sindhu , Levine Lisa
Published: December 2018

Objective To determine if increasing predicted risk of cesarean was associated with longer labor length and increased morbidity among women undergoing induction with an unfavorable cervix.

Study Design Using a publically available database, we evaluated whether a previously validated prediction model for cesarean delivery after induction was associated with labor length, maternal morbidity (third-/fourth-degree lacerations, endometritis, blood transfusion, wound infection, venous thromboembolism, hysterectomy, intensive care unit admission, and death), and neonatal morbidity (blood transfusion, encephalopathy, intraventricular hemorrhage, severe respiratory distress syndrome, necrotizing enterocolitis, and sepsis). Full-term (≥37 weeks) singleton gestations with intact membranes and an unfavorable cervix (Bishop score ≤6 and dilation ≤2 cm) undergoing induction of labor were included.

Results A total of 8,466 women met the inclusion criteria. Each category increase in cesarean probability (<20, 20–39.9, 40–59.9, ≥60%) was associated with an increase in labor length (9.6, 10.8, 11.7, and 11.9 hours, respectively; p < 0.001). With increasing predicted probability of cesarean there, was also a significant increase in maternal morbidity with each category (2.6, 4.7, 5.1, 6.1%; p = 0.001) and increase in neonatal morbidity (0.9, 1.5, 2, 2.2%; p = 0.002).

Conclusion Using a validated prediction model for cesarean delivery among women induced with an unfavorable cervix, increasing predicted probability of cesarean is associated with longer labor length and increased maternal and neonatal morbidity.
Minimally Invasive Interventional Management of Osteoarthritic Chronic Knee Pain
Authors: Jones Mark , Patel Riki , Adamian Leena , Seifert Danica , Thompson William , Viswanath Omar , Urits Ivan
Published: November 2018

Chronic knee pain is a widely prevalent issue that can have a significant impact on a patient's quality of life. One of the leading causes of chronic knee pain is osteoarthritis. Total knee replacement is often the last and definitive resort for patients with severe symptomatic osteoarthritis after trial of less invasive interventions with failure to achieve symptomatic relief. Intra-articular injections are a mainstay of adjunctive conservative management and have demonstrated efficacy in reducing pain. Radiofrequency treatment is a viable option for poor surgical candidates, or for patients having persistent, chronic pain following knee surgery. Extracorporeal shockwave therapy is another modality growing in use that may offer short-term symptomatic relief. In this review, we will discuss widely used minimally invasive interventional options for the symptomatic management of osteoarthritic chronic knee pain.
Effects of Surgery and Radiotherapy on Recurrent Skull Base Meningiomas: Clinical and Biological Analyses
Authors: Ichimura Shinya , Kawase Takeshi
Published: December 2018

We reviewed the medical records of 392 patients who underwent initial surgery for skull base meningiomas between 1983 and 2008. Among them, 32 (8.2%) showed tumor recurrence. Risk factors for recurrence were analyzed clinically and biologically. Recurrent cases were treated with radiotherapy, surgery, or both. In reoperation cases, pathological and biological changes were analyzed and compared between groups with or without radiotherapy. The recurrence rate was statistically high in cases of partial tumor removal and in patients with tumor in the cavernous sinus, tumors with histological WHO (World Health Organization) grade ≥ II or MIB-1 index > 3. The local control rate of postoperative radiotherapy for recurrent cases was 66.7%. Malignant transformation and MIB-1 index elevation was observed more frequently in patients who underwent reoperation after radiotherapy than in the reoperation-only group. Risk factors for recurrence of skull base meningiomas are as follows: (1) partial tumor removal, (2) tumor in the cavernous sinus, (3) histological WHO grade ≥ II, or (4) MIB-1 index > 3. Postoperative radiotherapy might be effective for tumor recurrence. However, the indications for radiotherapy should be carefully considered because postsurgical radiotherapy may increase biological activity, inducing malignant transformation.
Reflexivity and Queer Embodiment: Some Reflections on Sexualities Research in Ghana
Authors: Gore Ellie
Published: November 2018

The ‘reflexive turn’ transcended disciplinary boundaries within the social sciences. Feminist scholars in particular have taken up its core concerns, establishing a wide-ranging literature on reflexivity in feminist theory and practice. In this paper, I contribute to this scholarship by deconstructing the ‘story’ of my own research as a white, genderqueer, masculine-presenting researcher in Ghana. This deconstruction is based on thirteen months of field research exploring LGBT activism in the capital city of Accra. Using a series of ethnographic vignettes, I examine questions of queer subjectivity, embodiment and self/Other dynamics in the research encounter. Specifically, I interrogate what a reflexive concern for power relations means when researchers share moments of commonality and difference with research participants, here in relation to axes of gender, sexuality, race and class. Finally, I explore the challenge of theorising resistance in light of feminist postcolonial critiques of the politics of representation. I conclude that it is only by locating these tensions and dissonances in the foreground of our inquiries that reflexivity becomes meaningful as a way of rendering knowledge production more accountable and transparent, of practising feminist solidarity, and of excavating our own queer research journeys.
Cumulative culture and explicit metacognition: a review of theories, evidence and key predictions
Authors: Dunstone Juliet , Caldwell Christine A.
Published: December 2018

A variety of different proposals have attempted to explain the apparent uniqueness of human cumulative culture as a consequence of underlying mechanisms that are also assumed to be uniquely well-developed in humans. Recently, Heyes and colleagues have proposed explicit (or Type 2) metacognition as a key feature of human cognition that might enable cumulative culture. In the current review we examine these arguments, and consider their plausibility. Firstly we consider whether distinctions between cognitive processes described as explicit/implicit, and Type 1/2 (or Systems 1/2), do indeed capture features that distinguish processes specific to human cognition, versus those that are shared with other species. In particular we consider whether this applies to distinctions relating to metacognitive processes. We also consider the ways in which explicit metacognitive processing might plausibly facilitate cumulative culture. We categorise the potential benefits as either optimising receiver behaviour, or optimising sender behaviour. Within both of these categories benefits could arise as a consequence of more effective representation of either one’s own knowledge state, or that of others. We evaluate the current state of evidence supporting each of these potential benefits. We conclude by proposing methodological approaches that could be used to directly test the theory, and also identify which (if any) of the possible causal mechanisms may be implicated.
FGF-2 inhibits contractile properties of valvular interstitial cell myofibroblasts encapsulated in 3D MMP-degradable hydrogels
Authors: Gonzalez Rodriguez Andrea , Schroeder Megan E. , Walker Cierra J. , Anseth Kristi S.
Published: December 2018

Valvular interstitial cells (VICs) are responsible for the maintenance of the extracellular matrix in heart valve leaflets and, in response to injury, activate from a quiescent fibroblast to a wound healing myofibroblast phenotype. Under normal conditions, myofibroblast activation is transient, but the chronic presence of activated VICs can lead to valve diseases, such as fibrotic aortic valve stenosis, for which non-surgical treatments remain elusive. We monitored the porcine VIC response to exogenously delivered fibroblast growth factor 2 (FGF-2; 100 ng/ml), transforming growth factor beta 1 (TGF-β1; 5 ng/ml), or a combination of the two while cultured within 3D matrix metalloproteinase (MMP)-degradable 8-arm 40 kDa poly(ethylene glycol) hydrogels that mimic aspects of the aortic valve. Here, we aimed to investigate VIC myofibroblast activation and subsequent contraction or the reparative wound healing response. To this end, VIC morphology, proliferation, gene expression related to the myofibroblast phenotype [alpha smooth muscle actin (α-SMA) and connective tissue growth factor (CTGF)] and matrix remodeling [collagens (COL1A1 and COL3) and MMP1], and contraction assays were used to quantify the cell response. Treatment with FGF-2 resulted in increased cellular proliferation while reducing the myofibroblast phenotype, as seen by decreased expression of CTGF and α-SMA, and reduced contraction relative to untreated control, suggesting that FGF-2 encourages a reparative phenotype, even in the presence of TGF-β1. TGF-β1 treatment predictably led to an increased proportion of VICs exhibiting the myofibroblast phenotype, indicated by the presence of α-SMA, increased gene expression indicative of matrix remodeling, and bulk contraction of the hydrogels. Functional contraction assays and biomechanical analyses were performed on VIC encapsulated hydrogels and porcine aortic valve tissue explants to validate these findings.
Effects of magnetization conditions on dynamic characteristics of spacecrafts with superconducting flux pinning docking interfaces
Authors: Yang Wenjiang , Liao Dongping , Ji Yu , Yao Lu
Published: December 2018

Depending on the self-stable levitation characteristics of superconductors with trapped magnetic flux, superconducting flux pinning docking interfaces (FPDIs) provide a promising approach for space applications. In this paper, we investigate the influence of magnetization conditions on the dynamic response between two satellites equipped with FPDIs. The flux pinning interactions between a high-temperature superconductor and a source magnet are approximated using a frozen image model. An analytic model of the docking process is derived based on the Kane method to simulate the dynamic response. A linearized dynamic model is derived, and linear quadratic regulator (LQR) control is applied to the FPDI to minimize the relative attitude deviations. The results show that improving the frozen magnetic flux density of superconductors is beneficial to the capture ability of the FPDI. Increasing the damping coefficient is also an efficient approach to improving the docking performance, but this approach is limited by the field cooling height. Damping materials with a lower density and a higher damping coefficient are proposed to be employed in the FPDI. The LQR control contributes to suppressing the amplitude of the oscillation and reducing the settling time in the docking process. Although the amplitude of oscillation in a noncontrol scheme converges more slowly than the LQR control scheme, it does not require the high dynamic response speed of a control system like the LQR control scheme, which contributes toward simplifying the structure of the FPDI. The principles presented above provide a guide for the design and implementation of FPDI in space docking missions.
ROSE bitumen: Mesoscopic model of bitumen and bituminous mixtures
Authors: Lemarchand Claire A. , Greenfield Michael L. , Dyre Jeppe C. , Hansen J. S.
Published: December 2018

We present a mesoscopic model for bitumen and bituminous mixtures. The model, which is based on dissipative particle dynamics, consists of different dynamical entities that represent the different characteristic time scales. Through the stress relaxation function, the mechanical properties of the model are investigated. For pure bitumen, the viscosity features super-Arrhenius behavior in the low-temperature regime in agreement with experimental data. The frequency-dependent viscoelastic properties show purely viscous behavior at low frequencies with increasing elasticity and hardening at higher frequencies, as expected. The model dynamics are analyzed in the framework of longitudinal hydrodynamics. The thermal process is two orders of magnitude slower than the attenuation of the density-wave propagation; hence the dynamic structure factor is dominated by a sharp Rayleigh peak and a relatively broad Brillouin peak. The model is applied to study triblock-copolymer-modified bitumen mixtures. Effects of the polymer concentration and end-block interactions with the bitumen are investigated. While the polymer concentration has an effect on the mechanical properties, the effect of increasing repulsive interactions between the bitumen and the polymer end-blocks is much more dramatic; it increases the viscosity of the mixture and shifts the onset of the elastic behavior to lower frequencies. For increased repulsion, the polymer end-blocks form small clusters that can be connected by a dynamic polymer backbone network. A simple Flory-Huggins analysis reveals the onset of segregation of the end-blocks in the bitumen mixture in agreement with the simulation data. Hence the changed mechanical properties are due to the emergence of large-scale structures as the repulsion is increased, which conforms to known mechanisms of microphase separation in polymer-modified bitumens.
Identification of on-target mutagenesis during correction of a beta-thalassemia splice mutation in iPS cells with optimised CRISPR/Cas9-double nickase reveals potential safety concerns
Authors: Alateeq Suad , Ovchinnikov Dmitry , Tracey Timothy , Whitworth Deanne , Al-Rubaish Abdullah , Al-Ali Amein , Wolvetang Ernst
Published: December 2018

Precise and accurate gene correction is crucial for enabling iPSC-based therapies, and Cas9-Nickase based approaches are increasingly considered for in vivo correction of diseases such as beta-thalassemia. Here, we generate footprint-free induced pluripotent stem cells from a patient with a beta-thalassemia mutation (IVSII-1 G > A) and employ a double Cas9nickase-mediated correction strategy combined with a piggyBac transposon-modified donor vector for gene correction. Our approach further aimed to minimize the formation of adjacent single-strand breaks at the targeted allele through the destruction of the binding site for one guide and the use of a synonymous protospacer adjacent motif blocking mutation (canonical PAM sequence 5'-NGG-3' is changed to 5'-NCG-3', where N indicates any nucleobase) for the other guide. We show that this strategy indeed not only permits bi-allelic seamless repair of the beta-globin gene splice site mutation and negligible off-target mutagenesis or re-editing of the targeted allele but also results in unexpected on-target mutagenesis with some guide RNAs (gRNAs) in several targeted clones. This study thus not only validates a framework for seamless gene correction with enhanced specificity and accuracy but also highlights potential safety concerns associated with Cas9-nickase based gene correction.
Temperature-dependent interface stability of MoO3/GaAs(001) hybrid structures
Authors: Ashraf Tanveer , Sarkar Anirban , Grafeneder Wolfgang , Koch Reinhold
Published: December 2018

We report on the influence of growth temperature and post-growth annealing on interface formation and film structure of thin MoO3 films on GaAs(001), which plays an important role for a future application as carrier-selective contacts or diffusion barriers in III/V-semiconductor spin- and optoelectronics or photovoltaics. Growth and post-growth annealing were performed in a manner that emulates heterostructure growth and lithographic processing. High-resolution transmission electron microscopy reveals nanocrystalline (“amorphous”) growth at temperatures up to 200°C and a transition to polycrystalline growth at about 400°C. Spatially resolved chemical analysis by energy dispersive x-ray spectroscopy reveals strong intermixing at the MoO3/GaAs(001) interface proceeding during both film deposition and annealing. Our results evidence the important role of intermixing occurring during the process of interface formation at the very beginning of deposition.
Study of sterilization effects on marine Vibrio sp. using interaction of cavitation with shock wave in a narrow water chamber
Authors: Wang Jingzhu , Abe Akihisa , Koita Taketoshi , Sun Mingyu , Wang Yiwei , Huang Chenguang
Published: December 2018

Cavitation bubbles could also be called as inertial bubbles because of their oscillation due to the pressure difference between inside and outside. After the passage of an underwater shock wave, the violent collapses of the bubbles are induced and could produce stronger mechanical and biochemical actions so that the marine bacteria around them are inactivated by those productions. In the present study, cavitation inertial bubbles are observed behind multiple waves in a narrow water chamber after an electric discharge is triggered and then interacts with underwater reflected shock waves from the water chamber. The sterilization effects of only these oscillating bubbles and cavitation-shock interaction are investigated by bio-experiments of marine Vibrio sp. The results show that a high sterilization is obtained in the case of the cavitation-shock interaction. Furthermore, the chemical action of free radicals mainly contributes to inactivating the marine bacteria. The generation of the hydroxyl (OH) radicals is clarified by measuring the concentration of H2O2. Subsequently, we focus on a theoretical analysis of the generation condition of the OH radicals by a bubble dynamic model consisting of an oscillation model and an impact model. Finally, the theoretical estimation by the bubble dynamic model is discussed under the conditions of the present experiments. As a result, there is a possibility of effective sterilization by the cavitation-shock interaction without the supply of air microbubbles.
Enhanced surface passivation of predictable quantum efficient detectors by silicon nitride and silicon oxynitride/silicon nitride stack
Authors: Stokkan Therese Sørheim , Haug Halvard , Tang Chi Kwong , Marstein Erik Stensrud , Gran Jarle
Published: December 2018

In this paper, we investigate three different passivating films for use in predictable quantum efficient detectors: two monolayer films of SiNx with different compositions and one double-layer stack of SiNxOy capped with SiNx, all deposited on very high resistivity silicon substrates. In addition to the conventional characterization methods, we also utilize the novel method of photoluminescence imaging under applied bias (PL-V) and high voltage soaking to modulate the fixed charge density Qf in the layers. All films exhibit very good passivating properties after deposition and annealing, with the oxynitride stack providing the best passivation, resulting in an effective carrier lifetime close to 20 ms. This value is explained by a relatively high fixed charge density of Qf = 1.12 × 1012 cm−2 and low interface defect density (S0,n = 6.0 × 102 cm/s), giving a chemical passivation which is an order of magnitude better than the investigated nitrides. Both nitride films were readily charged by voltage soaking, increasing the effective carrier lifetime by about 20%. Based on the passivating properties, photodetector device simulations predict that self-induced photodiodes made with any of these passivation layers will have an internal quantum deficiency well below 1 ppm for selected wavelengths at room temperature, and all the investigated materials are thus good candidates for use as passivating layers in such photodiodes.
On the breakdown of the Ehrenfest method for molecular dynamics on surfaces
Authors: Loaiza Ignacio , Izmaylov Artur F.
Published: December 2018

Due to a continuum of electronic states present in periodic systems, the description of molecular dynamics on surfaces poses a serious computational challenge. One of the most used families of approaches in these settings are friction theories, which up to a random fluctuating force term are based on the Ehrenfest approach. Yet, a mean-field treatment of electronic degrees of freedom in the Ehrenfest method makes this approach inaccurate in some cases. Our aim is to clarify when Ehrenfest breaks down for molecular dynamics on surfaces. Answering this question provides limits of applicability for more approximate friction theories derived from Ehrenfest. We assess the Ehrenfest method on one-dimensional, numerically exactly solvable models with a large but finite number of electronic states. Using the Landau-Zener formula and the Massey parameter, an expression that determines when Ehrenfest breaks down is deduced.
Energy analysis of the three-vertex Potts model ground state
Authors: Babaev A. B. , Murtazaev A. K. , Kassan-Ogly F. A.
Published: November 2018

An energy analysis of the ground state in the triangular lattice three-state Potts model is conducted with allowance for the contribution of the nearest and next-nearest neighbors having interaction values J1 and J2. The ranges of existence of ordered and disordered phases in the spin structures described by this model, with the interaction values J1 < 0, J2 < 0 and J1 > 0, J2 < 0, are inferred from the numerical experiment.
On the ground-state energy of a finite inhomogeneous degenerate Bose gas
Authors: Bobrov V. B. , Zagorodny A. G. , Trigger S. A.
Published: November 2018

The ground-state energy of a finite inhomogeneous system of bosons located in a scalar external field was found within the framework of the self-consistent Hartree-Fock approximation, on the basis of the representation of the second quantization without using the formalism of anomalous averages. The ground-state wave function corresponds to the stationary Gross-Pitaevskii equation for the Bose-Einstein condensate wave function. It was shown that the ground-state energy can be found using the energy determined by the stationary Gross-Pitaevskii equation only for a system that satisfies the thermodynamic limit.
Evanescent-wave tuning of a locally resonant sonic crystal
Authors: Wang Ting-Ting , Wang Yan-Feng , Wang Yue-Sheng , Laude Vincent
Published: December 2018

Locally resonant sonic crystals can support band gaps at low frequencies defined by resonances internal to the unit cell. Band gap frequencies are dictated by the choice of resonators and their interaction with the medium supporting acoustic wave propagation. We show that locally resonant band gaps can be tuned by engineering the dispersion of the evanescent waves appearing in the propagation medium at the resonator sites. Specifically, we experimentally consider a tubular waveguide filled with different levels of water and grafted with a periodic array of acoustic resonators. Water filling continuously tunes the dispersion of evanescent waves by changing the waveguide cross-section. Dispersion relations and transmission properties are obtained with a three-dimensional time-harmonic finite element model of wave propagation. Numerical and experimental results are found to be in good agreement. The present work is relevant to the practical design of tunable acoustic devices.
Supporting Northern Territory Top End allied health graduates and early career staff by means of an interprofessional graduate program
Authors: Sooful Prasha , Williams Justine , Moore Renae
Published: November 2018

Objectives For allied health graduate staff, entry into the workforce can be challenging and complex to navigate. Formal, structured graduate programs in the Northern Territory are limited and are typically discipline specific. Discipline-specific graduate programs focus on clinical and specific skill sets. However, there is a need to support graduates and early career staff within a diverse and large health service by developing and encouraging interprofessional practice, as well as reflective and critical thinking skills. This article outlines a pilot inter-professional allied health graduate program trialled in the Northern Territory Top End, including program development, implementation and outcomes. Methods A formative study design using online pre- and post-program surveys for participants and their line managers was adopted. Results There was significant improvement noted in the graduates’ confidence levels of understanding other professional roles after the pilot program. Graduates also reported an improved sense of support and reflective skills moving into their subsequent year of professional practice. Managers of graduates reported improved interprofessional practice and collaboration with other health professionals. Conclusions The pilot program provided a sustainable model of learning and development for early career allied health professionals. Supporting the Top End graduate allied health workforce proved to be an important factor in facilitating interprofessional practice from an early stage, as integrated care and interprofessional practice are crucial to patient treatment. What is known about the topic? Research from within Australia and internationally has demonstrated that preparing allied health professionals for interprofessional practice helped facilitate collaboration and partnerships among different professions. This, in turn, improved quality of patient health care outcomes. Interprofessional education has been documented as an effective means of educating clinicians. What does this paper add? This paper describes how interprofessional learning and education in the form of a structured graduate program affected the perceptions of staff and implementation of interprofessional practice in the Northern Territory (NT). The Top End of the NT is unique in that a large number of allied health professionals work within integrated multidisciplinary teams or hold sole positions within regional settings. This is the first graduate program for NT allied health professionals. What are the implications for practitioners? Allied health professionals are an integral part of a health service and fostering interprofessional practice early on can prepare new employees to collaborate and support each other with an understanding of the roles of other professionals.
Grizzel Greedigut: A Name ‘No Mortall Could Invent’
Authors: Pentangelo Joseph
Published: December 2018

Matthew Hopkins, England’s most notorious witch hunter, rested his reputation on his experience in confronting the supernatural. To this end, he greatly exaggerated the intensity of his first encounter with an accused witch, Elizabeth Clarke. In Hopkins’ account, Clarke mentioned a familiar named Grizzel Greedigut. But earlier publications show that this did not happen, and that Hopkins appropriated the name from the dubious confession of another woman, Joan Wallis. Today, we have largely accepted Grizzel Greedigut as a bizarre, nonsensical name, but it would not have been all that absurd at the time. Grizzle often described grey animals, and Grissel was a fairly popular name, an abbreviation of Grisilde. Greedigut meant ‘glutton,’ and was the name English colonials used for the American anglerfish. Without knowing more about the name’s historical context, we fall for Hopkins’ cynical ploy to maximize the strangeness of his encounter.
An interview with Peter Pruzan on spiritual transformation in management
Authors: Pruzan Peter , Zsolnai Laszlo
Published: November 2018

This interview with Peter Pruzan shows his personal and professional journey from optimization to transformation, a path to the wellspring of rationality, ethics and spirituality.
Molecular dissection of multiphase inactivation of the bacterial sodium channel NaVAb
Authors: Gamal El-Din Tamer M. , Lenaeus Michael J. , Ramanadane Karthik , Zheng Ning , Catterall William A.
Published: December 2018

Homotetrameric bacterial voltage-gated sodium channels share major biophysical features with their more complex eukaryotic counterparts, including a slow-inactivation mechanism that reduces ion-conductance activity during prolonged depolarization through conformational changes in the pore. The bacterial sodium channel NaVAb activates at very negative membrane potentials and inactivates through a multiphase slow-inactivation mechanism. Early voltage-dependent inactivation during one depolarization is followed by late use-dependent inactivation during repetitive depolarization. Mutations that change the molecular volume of Thr206 in the pore-lining S6 segment can enhance or strongly block early voltage-dependent inactivation, suggesting that this residue serves as a molecular hub controlling the coupling of activation to inactivation. In contrast, truncation of the C-terminal tail enhances the early phase of inactivation yet completely blocks late use-dependent inactivation. Determination of the structure of a C-terminal tail truncation mutant and molecular modeling of conformational changes at Thr206 and the S6 activation gate led to a two-step model of these gating processes. First, bending of the S6 segment, local protein interactions dependent on the size of Thr206, and exchange of hydrogen-bonding partners at the level of Thr206 trigger pore opening followed by the early phase of voltage-dependent inactivation. Thereafter, conformational changes in the C-terminal tail lead to late use-dependent inactivation. These results have important implications for the sequence of conformational changes that lead to multiphase inactivation of NaVAb and other sodium channels.
Inotropic interventions do not change the resting state of myosin motors during cardiac diastole
Authors: Caremani Marco , Pinzauti Francesca , Powers Joseph D. , Governali Serena , Narayanan Theyencheri , Stienen Ger J.M. , Reconditi Massimo , Linari Marco , Lombardi Vincenzo , Piazzesi Gabriella
Published: December 2018

When striated (skeletal and cardiac) muscle is in its relaxed state, myosin motors are packed in helical tracks on the surface of the thick filament, folded toward the center of the sarcomere, and unable to bind actin or hydrolyze ATP (OFF state). This raises the question of whatthe mechanism is that integrates the Ca2+-dependent thin filament activation, making myosin heads available for interaction with actin. Here we test the interdependency of the thin and thick filament regulatory mechanisms in intact trabeculae from the rat heart. We record the x-ray diffraction signals that mark the state of the thick filament during inotropic interventions (increase in sarcomere length from 1.95 to 2.25 µm and addition of 10−7 M isoprenaline), which potentiate the twitch force developed by an electrically paced trabecula by up to twofold. During diastole, none of the signals related to the OFF state of the thick filament are significantly affected by these interventions, except the intensity of both myosin-binding protein C– and troponin-related meridional reflections, which reduce by 20% in the presence of isoprenaline. These results indicate that recruitment of myosin motors from their OFF state occurs independently and downstream from thin filament activation. This is in agreement with the recently discovered mechanism based on thick filament mechanosensing in which the number of motors available for interaction with actin rapidly adapts to the stress on the thick filament and thus to the loading conditions of the contraction. The gain of this positive feedback may be modulated by both sarcomere length and the degree of phosphorylation of myosin-binding protein C.
Neural Interactions Underlying Visuomotor Associations in the Human Brain
Authors: Madhavan Radhika , Bansal Arjun K , Madsen Joseph R , Golby Alexandra J , Tierney Travis S , Eskandar Emad N , Anderson William S , Kreiman Gabriel
Published: December 2018

Rapid and flexible learning during behavioral choices is critical to our daily endeavors and constitutes a hallmark of dynamic reasoning. An important paradigm to examine flexible behavior involves learning new arbitrary associations mapping visual inputs to motor outputs. We conjectured that visuomotor rules are instantiated by translating visual signals into actions through dynamic interactions between visual, frontal and motor cortex. We evaluated the neural representation of such visuomotor rules by performing intracranial field potential recordings in epilepsy subjects during a rule-learning delayed match-to-behavior task. Learning new visuomotor mappings led to the emergence of specific responses associating visual signals with motor outputs in 3 anatomical clusters in frontal, anteroventral temporal and posterior parietal cortex. After learning, mapping selective signals during the delay period showed interactions with visual and motor signals. These observations provide initial steps towards elucidating the dynamic circuits underlying flexible behavior and how communication between subregions of frontal, temporal, and parietal cortex leads to rapid learning of task-relevant choices.
Role of Epithelial-to-Mesenchymal Transition in Inflammatory Bowel Disease
Authors: Lovisa Sara , Genovese Giannicola , Danese Silvio
Published: December 2018

Intestinal fibrosis is an inevitable complication in patients with inflammatory bowel disease [IBD], occurring in its two major clinical manifestations: ulcerative colitis and Crohn’s disease. Fibrosis represents the final outcome of the host reaction to persistent inflammation, which triggers a prolonged wound healing response resulting in the excessive deposition of extracellular matrix, eventually leading to intestinal dysfunction. The process of epithelial-to-mesenchymal transition [EMT] represents an embryonic program relaunched during wound healing, fibrosis and cancer. Here we discuss the initial observations and the most recent findings highlighting the role of EMT in IBD-associated intestinal fibrosis and fistulae formation. In addition, we briefly review knowledge on the cognate process of endothelial-to-mesenchymal transition [EndMT]. Understanding EMT functionality and the molecular mechanisms underlying the activation of this mesenchymal programme will permit designing new therapeutic strategies to halt the fibrogenic response in the intestine.
Effect of Balance Training After Hip Fracture Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies
Authors: Lee Sang Yoon , Jung Se Hee , Lee Shi-Uk , Ha Yong-Chan , Lim Jae-Young
Published: December 2018

Background

Although balance impairment after hip fracture surgery (HFS) can constitute a long-term problem of limiting mobility and increasing the risk of falls in older adults, little is known about the effect of balance training (BT) on physical functioning after HFS. Thus, we performed a meta-analysis to evaluate whether BT improved the overall physical functioning of patients after HFS.

Methods

We searched the PubMed-Medline, Embase, and Cochrane Library databases in January 2018 and included all randomized controlled trials comparing BT with usual care after HFS. We performed a pairwise meta-analysis using fixed- and random-effects models.

Results

Eight randomized controlled trials including a total of 752 participants were retrieved. The BT group showed significantly improved overall physical functioning after HFS compared with the usual care group (overall standardized mean difference [SMD] = 0.390; 95% confidence interval [CI] = 0.114–0.667; p = .006). Both, balance and gait improved (SMD = 0.570; 95% CI = 0.149–0.992; p = .008 and SMD = 0.195; 95% CI = 0.043–0.347; p = .012, respectively) in the BT group. Lower limb strength, performance task, activity of daily living, and health-related quality of life also improved significantly in the BT group.

Conclusion

Our meta-analysis revealed that BT after HFS improved overall physical functioning. Positive effects on balance, gait, lower limb strength, performance task, activity of daily living, and health-related quality of life were evident. Therefore, BT should be specifically included in postoperative rehabilitation programs and balance must be thoroughly checked in elderly patients with hip fractures.
Geriatric Health Charts for Individual Assessment and Prediction of Care Needs: A Population-Based Prospective Study
Authors: Santoni Giola , Calderón-Larrañaga Amaia , Vetrano Davide L , Welmer Anna-Karin , Orsini Nicola , Fratiglioni Laura
Published: December 2018

Background

Geriatric health charts that are similar to pediatric growth charts could facilitate monitoring health changes and predicting care needs in older adults. We aimed to validate an existing composite score (Health Assessment Tool [HAT]) and provide provisional age-specific reference curves for the general older population.

Methods

Data came from the Swedish National study on Aging and Care in Kungsholmen (N = 3,363 participants aged 60 years and over examined clinically at baseline and 3 years later). HAT was validated by exploring its relationship with health indicators (logistic regression) and comparing its ability to predict care consumption with that of two of its components, morbidity and disability (receiver operating characteristic curve areas). A flowchart was developed to obtain individual-level HAT scores (nominal response method). Sex-specific health charts were derived by graphing seven percentile curves of age-related HAT change (logistic quantile regression).

Results

HAT scores above the age- and sex-specific median were related to good performance in chair-stand tests (odds ratio [OR] = 2.62, 95% confidence interval [CI]: 2.07–3.31), balance and grip tests (interaction balance grip test, OR = 1.15, 95% CI: 1.05–1.25), and good self-rated health (OR = 2.19, 95% CI: 1.77–2.71). Receiver operating characteristic curve areas (HAT vs number of chronic disorders) were formal care, 0.76 versus 0.58 (p value < .001); informal care, 0.74 versus 0.59 (p value < .001); hospital admission, 0.70 versus 0.66 (p value < .001); primary care visits, 0.71 versus 0.69 (p value > .05); and specialty care visits, 0.62 versus 0.65 (p value < .001). HAT consistently predicted medical and social care service use better than disability.

Conclusions

HAT is a valid tool that predicts care consumption well and could be useful in developing geriatric health charts to better monitor health changes in older populations.
Reflection on modern methods: years of life lost due to premature mortality—a versatile and comprehensive measure for monitoring non-communicable disease mortality
Authors: Martinez Ramon , Soliz Patricia , Caixeta Roberta , Ordunez Pedro
Published: December 2018

The analysis of causes impacting on premature mortality is an essential function of public health surveillance. Diverse methods have been used for accurately assessing and reporting the level and trends of premature mortality; however, many have important limitations, particularly in capturing actual early deaths. We argue that the framework of years of life lost (YLL), as conceptualized in disability-adjusted life-years (DALYs), is a robust and comprehensive measure of premature mortality. Global Burden of Disease study is systematically providing estimates of YLL; however, it is not widely adopted at country level, among other reasons because its conceptual and methodological bases seem to be not sufficiently known and understood. In this paper, we provide the concepts and the methodology of the YLL framework, including the selection of the loss of function that defines the time lost due to premature deaths, and detailed methods for calculating YLL metrics. We also illustrate how to use YLL to quantify the level and trends of premature non-communicable disease (NCD) mortality in the Americas. The tutorial style of the illustrative example is intended to educate the public health community and stimulate the use of YLL in disease prevention and control programmes at different levels.
Fair compute loads enabled by blockchain: sharing models by alternating client and server roles
Authors: Kuo Tsung-Ting , Gabriel Rodney A , Ohno-Machado Lucila
Published: December 2018

Objective

Decentralized privacy-preserving predictive modeling enables multiple institutions to learn a more generalizable model on healthcare or genomic data by sharing the partially trained models instead of patient-level data, while avoiding risks such as single point of control. State-of-the-art blockchain-based methods remove the “server” role but can be less accurate than models that rely on a server. Therefore, we aim at developing a general model sharing framework to preserve predictive correctness, mitigate the risks of a centralized architecture, and compute the models in a fair way

Materials and Methods

We propose a framework that includes both server and “client” roles to preserve correctness. We adopt a blockchain network to obtain the benefits of decentralization, by alternating the roles for each site to ensure computational fairness. Also, we developed GloreChain (Grid Binary LOgistic REgression on Permissioned BlockChain) as a concrete example, and compared it to a centralized algorithm on 3 healthcare or genomic datasets to evaluate predictive correctness, number of learning iterations and execution time

Results

GloreChain performs exactly the same as the centralized method in terms of correctness and number of iterations. It inherits the advantages of blockchain, at the cost of increased time to reach a consensus model

Discussion

Our framework is general or flexible and can also address intrinsic challenges of blockchain networks. Further investigations will focus on higher-dimensional datasets, additional use cases, privacy-preserving quality concerns, and ethical, legal, and social implications

Conclusions

Our framework provides a promising potential for institutions to learn a predictive model based on healthcare or genomic data in a privacy-preserving and decentralized way.