bluuebunny/crossref_metadata_2025 huggingface dataset:
Orale Gesundheit und Schwangerschaft – Patientinnenbefragung anhand eines Fragebogens
Authors: Odermatt Tobias , Schötzau Andreas , Hoesli Irene
Published: March 2019

Hintergrund und Fragestellung Die vorliegende Studie ging der Frage nach, wie gut die schwangeren Patientinnen über die Ursachen und Auswirkungen einer Schwangerschaftsgingivitis informiert waren. Die Faktoren Alter, Bildung und Herkunft sollten untersucht werde. Daten zum Mundhygieneverhalten sollten aufgenommen und Unterschiede zwischen ambulanten und stationären Schwangeren aufgezeigt werden. Mögliche Risikofaktoren bezüglich des Geburtsoutcomes galt es zu definieren.

Methodik Anhand eines Fragebogens wurden 83 Patientinnen (40 ambulant/43 stationär) zum Mundhygieneverhalten und zum Wissensstand bezüglich den Ursachen und Auswirkungen einer Gingivitis befragt. Bei 50 Patientinnen wurden zusätzlich die Daten über das Geburtsoutcome erhoben.

Ergebnisse Beim Vergleich wie gut die Schwangeren über die Auswirkungen einer Gingivitis informiert waren, schnitten die stationären Studienteilnehmerinnen signifikant besser ab, als die ambulanten Patientinnen. Die Bildung hatte mit einem p-Wert von 0,016 einen statistisch signifikanten Einfluss auf das Geburtsoutcome. 24% der Befragten wurden von ihrem Arzt oder Zahnarzt über besondere Mundhygienemassnahmen während der Schwangerschaft informiert. Subjektiv wahrgenommene Entzündungszeichen wie z. B. Bluten beim Zähneputzen traten bei mehr als der Hälfte der Befragten auf. Auch Emesis gehörte mit 31% zu einem häufig verbreiteten Schwangerschaftsgebrechen. 24% der Studienteilnehmerinnen gaben an, die Mundhygiene während der Schwangerschaft mit zusätzlichen Mundhygienehilfsmitteln zu verbessern. 27% der Befragten waren seit über einem Jahr nicht mehr in einer zahnärztlichen Kontrolle.

Fazit Laut der vorliegenden Studie wurde nur jede vierte Schwangere von ihrem Gynäkologen über einen Zahnarztbesuch informiert. Diese tiefe Aufklärungsrate seitens der Gynäkologen mag zu einem Grossteil daran liegen, dass parodontale Erkrankungen dem Gynäkologen und Geburtshelfer nur wenig vertraut sind und daher auch weniger Beachtung finden. Sinnvollerweise würde die Gynäkologin bzw. der Gynäkologe der Schwangeren bereits beim ersten Kontrolluntersuch zu einem Besuch beim Zahnarzt raten. Insbesondere die Risikogruppen gilt es möglichst früh zu sensibilisieren und zur Verbesserung der Mundhygiene zu motivieren. Hier kommt der Zusammenarbeit zwischen Gynäkologen und Zahnärzten eine besondere Bedeutung zu.
Disruptive Managementmethoden: Agilität im Klinikeinkauf: ein theoretisches Konzept oder schon gelebte Praxis?
Authors: Schlüchtermann Jörg , Bächer Franziska , Köhler Mathias
Published: March 2019

Heutzutage sollen im Arbeitsleben alle möglichst flexibel im Sinne von anpassungsfähig sein – und der Trend setzt sich fort. Das Schlagwort lautet daher Agilität, womit nicht weniger gemeint ist als Anpassungsfähigkeit auf höchstmöglichem Niveau. Agilität wird zum zentralen Treiber für Wettbewerbsfähigkeit. Für den Praktiker erscheint es einerseits erstrebenswert, agil zu sein, andererseits wirken viele Fachbegriffe wie „Scrum“ oder „Sprint“ sperrig und sind Neuland für den Klinikbereich.
Acyl Transfer Strategies as Transient Activations for Enantioselective Synthesis
Authors: Rodriguez Jean , Quintard Adrien
Published: March 2019

In order to circumvent reactivity or selectivity issues associated with the addition of enolates to electrophiles, chemists have devised innovative methods involving transient activating groups. One of these powerful methods consists of the use of activated ketones, such as α-nitroketones, β-dicarbonyl compounds or β-ketosulfones, with electrophiles possessing a latent hydroxy or amine function. In the presence of a suitable catalyst, an enantioselective addition to the electrophile is facilitated triggering a subsequent Claisen-type fragmentation resulting in an acyl transfer. This subsequent step unveils the desired mono-activated function while directly transferring the ketone, forming in situ on the other side an ester or an amide.

1 Introduction

2 Intramolecular Acyl Transfer with Acyclic Substrates

2.1 Bifunctional Catalysis

2.2 Aminocatalysis

3 Intermolecular Acyl Transfer with Acyclic Substrates

4 Medium-Sized-Ring Formation with Cyclic Substrates

5 Conclusion
Matrix Poincaré, Φ-Sobolev inequalities, and quantum ensembles
Authors: Cheng Hao-Chung , Hsieh Min-Hsiu
Published: March 2019

Sobolev-type inequalities have been extensively studied in the frameworks of real-valued functions and non-commutative Lp spaces, and have proven useful in bounding the time evolution of classical/quantum Markov processes, among many other applications. In this paper, we consider yet another fundamental setting—matrix-valued functions—and prove new Sobolev-type inequalities for them. Our technical contributions are two-fold: (i) we establish a series of matrix Poincaré inequalities for separably convex functions and general functions with Gaussian unitary ensembles inputs; and (ii) we derive Φ-Sobolev inequalities for matrix-valued functions defined on Boolean hypercubes and for those with Gaussian distributions. Our results recover the corresponding classical inequalities (i.e., real-valued functions) when the matrix has one dimension. Finally, as an application of our technical outcomes, we derive the upper bounds for a fundamental entropic quantity—the Holevo quantity—in quantum information science since classical-quantum channels are a special instance of matrix-valued functions. This is obtained through the equivalence between the constants in the strong data processing inequality and the Φ-Sobolev inequality.
Resonant micro-instabilities at quasi-parallel collisionless shocks: Cause or consequence of shock (re)formation
Authors: Zeković Vladimir
Published: March 2019

A case of two interpenetrating, cold and quasi-neutral ion-electron plasmas is investigated with the multi-fluid approach. We consider that one plasma flows quasi-parallel to the lines of a background magnetic field embedded in another static plasma. If the flow turns super-Alfvénic, we show that parallel R/L-modes and perpendicular X/O-modes become unstable and grow in amplitude. Within the linear theory, we find that the growth rate curve of an unstable mode has a maximum at some wavenumber specific to each mode. If we consider a shock-like plasma configuration, we find that the fastest growing mode is the resonant one (with k∼rgi−1) which strongly interacts with ions. In Particle-In-Cell (PIC) simulations, we observe that a resonant wave with the same properties is excited during the early phases of shock formation. Once the wave becomes non-linear, it efficiently scatters ions and triggers the initial shock formation. This implies that the typical compression ratio of ∼4 could naturally arise as a consequence of a highly resonant micro-physical process. We model the interaction of ions reflected from the reforming shock barrier in a weak-beam case, and we show that the upstream wave now matches the instability we expect from the equations. By using PIC simulations, we explain how the strong-beam resonant instability triggers shock formation in the non-linear stage, and how the weak-beam instability reforms and transmits the shock afterwards. The micro-instabilities that we study here could largely contribute to shock triggering as well as to the reformation and transmission of the shock itself.
Role of non-linear effects and standing waves in microwave spectroscopy: Corbino measurements on superconductors and VO2
Authors: Zinßer Mario , Schlegel Katrin , Dressel Martin , Scheffler Marc
Published: March 2019

Broadband microwave spectroscopy can probe material properties in wide spectral and temperature ranges. The quality of such measurements crucially depends on the calibration, which also removes from the obtained spectra signatures of standing waves. Here we consider cryogenic Corbino-type reflection measurements on superconductors close to the critical temperature. We show that the non-linear sample response, which relates to sample heating, can lead to strong signatures of standing waves even in a well-calibrated Corbino spectrometer. We demonstrate our findings with microwave measurements as a function of frequency, power, and temperature and for different lengths of the microwave transmission line. Finally, we note such non-linear effects beyond the case of superconductors by probing a VO2 thin film at the insulator-metal transition.
Influence of H2O and O2 on the main discharge mechanism in 50 Hz ac point-plane corona discharge
Authors: Gao Qingqing , Wang Xiaohua , Yang Aijun , Niu Chunping , Rong Mingzhe , Jiao Lulu , Ma Qing
Published: March 2019

It is common to identify the internal insulation conditions of Sulfur Hexafluoride (SF6) insulated equipment by monitoring the concentrations of SF6 decomposition products. Corona discharge can lead to the decomposition of SF6, and thus, a lot of reactions occur in the mixture of SF6 with the impurities H2O and O2. Even under the same strength of corona discharge, the reactions can cause the decomposition products to differ due to the different concentrations of H2O and O2. This paper systematically studies the effects of H2O and O2 on the formation mechanism of SF6 decomposition products from a theoretical perspective. Two coupled zero-dimensional chemical kinetic models were built to investigate the discharge mechanism of 50 Hz ac point-plane corona discharge. By calculating the related contributions of the pathways at different moisture and oxygen contents (from 200 ppm to 5000 ppm), the main chemical process and the influence of the moisture and oxygen contents on the main discharge mechanism are analyzed.
Evidence of relationship between strain and In-incorporation: Growth of N-polar In-rich InAlN buffer layer by OMCVD
Authors: Chauhan P. , Hasenöhrl S. , Dobročka E. , Chauvat M. P. , Minj A. , Gucmann F. , Vančo Ľ. , Kováč J. , Kret S. , Ruterana P. , Kuball M. , Šiffalovič P. , Kuzmík J.
Published: March 2019

Two InxAl1−xN layers were grown simultaneously on different substrates [sapphire (0001) and the Ga-polar GaN template], but under the same reactor conditions, they were employed to investigate the mechanism of strain-driven compositional evolution. The resulting layers on different substrates exhibit different polarities and the layer grown on sapphire is N-polar. Moreover, for the two substrates, the difference in the degree of relaxation of the grown layers was almost 100%, leading to a large In-molar fraction difference of 0.32. Incorporation of In in InxAl1−xN layers was found to be significantly influenced by the strain imposed by the under-layers. With the evolutionary process of In-incorporation during subsequent layer growth along [0001], the direction of growth was investigated in detail by Auger electron spectroscopy. It is discovered that the In0.60Al0.40N layer grown directly on sapphire consists of two different regions with different molar fractions: the transition region and the uniform region. According to the detailed cross-sectional transmission electron microscopy, the transition region is formed near the hetero-interface due to the partial strain release caused by the generation of misfit-dislocations. The magnitude of residual strain in the uniform region decides the In-molar fraction. InxAl1−xN layers were analyzed by structural and optical characterization techniques. Our present work also shows that a multi-characterization approach to study InxAl1−xN is a prerequisite for their applications as a buffer layer.
The ratio of the number of states in asymmetric and symmetric ozone molecules deviates from the statistical value of 2
Authors: Gayday Igor , Teplukhin Alexander , Babikov Dmitri
Published: March 2019

Accurate calculations of vibrational states in singly and doubly substituted ozone molecules are carried out, up to dissociation threshold. Analysis of these spectra reveals noticeable deviations from the statistical factor of 2 for the ratio between the number of states in asymmetric and symmetric ozone molecules. It is found that, for the lower energy parts of spectra, the ratio is less than 2 in the singly substituted ozone molecules, but it is more than 2 in the doubly substituted ozone molecules. However, the upper parts of spectra, just below dissociation thresholds, exhibit a different behavior. In this energy range, the singly and doubly substituted ozone molecules behave similar, with the ratio of states in asymmetric and symmetric ozone molecules being more than 2 in both cases. This property may contribute to an explanation of the mysterious η-effect in the ozone forming reaction that favors the formation of the asymmetric ozone molecules.
Experimental trends of reflectometry frequency spectra emerging from a systematic analysis of the Tore Supra database
Authors: Sun Y. , Sabot R. , Heuraux S. , Garbet X. , Hacquin S. , Hornung G. , Verdoolaege G.
Published: March 2019

One major goal of data science applications is to extract patterns from large datasets. Such a database approach has been applied, for the first time in fusion science, towards a systematic study of the frequency spectra computed from reflectometry signals in the Tore Supra database, which are related to density fluctuations. In particular, the decomposition of reflectometry frequency spectra has allowed us to discover and quantify general trends of spectral characteristics (fractional contribution and width) for different components in Ohmic and low-confinement mode (L-mode) plasmas. In Ohmic plasmas, the contribution of the broadband component (EBB) to the total spectrum power in the saturated Ohmic confinement (SOC) regime is observed to be systematically higher than in the linear Ohmic confinement (LOC) regime. A transition of the dominating instability from TEM to ITG could explain the observed spectral modifications, which are supported by the analysis of the dependence of density peaking on collisionality. The spectral characteristics of the broadband (BB) and low-frequency (LF) components were then investigated in L-mode plasmas with ICRH or LH heating. The similar trends of the BB components with collisionality observed in L-mode plasmas compared with the Ohmic cases suggest a similar explanation by linking the frequency spectra to the underlying instabilities. The database analysis motivates more detailed studies by full-wave and gyrokinetic simulations, in order to confirm this link for both Ohmic and L-mode plasmas.
A galloping energy harvester with flow attachment
Authors: Tucker Harvey S. , Khovanov I. A. , Denissenko P.
Published: March 2019

Aeroelastic energy harvesters are a promising technology for powering wireless sensors and microelectromechanical systems. In this letter, we present a harvester inspired by the trembling of aspen leaves in barely noticeable winds. The galloping energy harvester, a curved blade oriented perpendicular to the flow, is capable of producing self-sustained oscillations at uncharacteristically low wind speeds. The dynamics of the harvesting system are studied experimentally and compared to a lumped parameter model. Numerical simulations quantitatively describe the experimentally observed dynamic behaviour. Flow visualisation is performed to investigate the patterns generated by the device. Dissimilar to many other galloping harvester designs, the flow is found to be attached at the rear surface of the blade when the blade is close to its zero displacement position, hence acting more closely to aerofoils rather than to conventionally used bluff bodies. Simulations of the device combined with a piezoelectric harvesting mechanism predict higher power output than that of a device with the square prism.
Electronic correlation and spin-orbit coupling in J1-J2 square lattice antiferromagnetism MoOPO4
Authors: Wang Runxue , Hao Xianfeng , Wang Cuihong , Zhang Xipeng , Sun Keju , Xu Yuanhui
Published: March 2019

We investigated the electronic and magnetic properties of the tetragonal molybdenum phosphate MoOPO4 by means of first-principles calculations based on the density functional theory within the semilocal generalized gradient approximation that includes the Hubbard repulsion term to take into account the electronic correlations. Furthermore, the spin-orbit coupling is explored through noncollinear magnetic calculations. Our results demonstrated that the Néel ordering on the square lattice plane, experimentally observed, is indeed the magnetic ground state on condition that the effective electronic correlation correction is smaller than 2.0 eV. Otherwise, the ferromagnetic alignment is established. In addition, the out-of-plane ferromagnetic interaction is well reproduced. The computed exchange constants, extracted from the classical Heisenberg model, show that the modest antiferromagnetic in-plane nearest-neighbor coupling plays a decisive role in the stabilization of the Néel spin alignment, in conjunction with the remarkable ferromagnetic in-plane next nearest-neighbor interaction. Moreover, the sign and relative amplitude of the exchange coupling parameters is sensitive to the correlation strength we applied. The density of states and spin density analysis demonstrated that the exclusively occupied dxy orbital results in the pure S = 1/2 spin moment and negligible spin-orbit coupling, which is originated from the large displacement of Mo ions inside the MoO6 octahedra along the apical direction.
Generation of bright γ-ray/hard x-ray flash with intense femtosecond pulses and double-layer targets
Authors: Liu Jianbo , Yu Jinqing , Shou Yinren , Wang Dahui , Hu Ronghao , Tang Yuhui , Wang Pengjie , Cao Zhengxuan , Mei Zhusong , Lin Chen , Lu Haiyang , Zhao Yanying , Zhu Kun , Yan Xueqing , Ma Wenjun
Published: March 2019

We study a method to generate collimated γ-ray/hard X-ray flash with high energy conversion efficiency and high peak brilliance by shooting a double-layer target with a readily available ultra-intense laser pulse. The target is composed of a homogeneous tens-of-micrometer-thick slightly underdense plasma (SUP) slab in front of an ultrathin foil. For optimal targets, particle-in-cell numerical simulations reveal that nonlinear Thomson scattering from directly accelerated superponderomotive electrons leads to the generation of a γ-ray flash with a peak brilliance of 1.6×1022 photons/s/mm2/0.1%BW at the MeV energy level at a laser intensity of 8.5×1020W/cm2. The dependence of the emission on the target parameters is systematically studied. Compared with using slightly overdense plasma, the use of SUP results in the enhancement of the photon number and brightness of the γ-ray flash by a factor of 10 and 40, respectively. The underlying physics of the enhancement is discussed.
Measuring heat flux from collective Thomson scattering with non-Maxwellian distribution functions
Authors: Henchen R. J. , Sherlock M. , Rozmus W. , Katz J. , Masson-Laborde P. E. , Cao D. , Palastro J. P. , Froula D. H.
Published: March 2019

Heat flux was measured in coronal plasmas using collective Thomson scattering from electron-plasma waves. A laser-produced plasma from a planar aluminum target created a temperature gradient along the target normal. Thomson scattering probed electron-plasma waves in the direction of the temperature gradient with phase velocities relevant to heat flux. The heat-flux measurements were reduced from classical values inferred from the measured plasma conditions in regions with large temperature gradients and agreed with classical values for weak gradients. In regions where classical theory was invalid, the heat flux was determined by reproducing the measured Thomson-scattering spectra using electron distribution functions consistent with nonlocal thermal transport. Full-scale hydrodynamic simulations using both flux-limited thermal transport (FLASH) and the multigroup nonlocal Schurtz, Nicolaï, and Busquet models underestimated the heat flux at all locations.
Rate limited filament formation in Al-ZnO-Al bipolar ReRAM cells and its impact on early current window closure during cycling
Authors: Chauhan Amit Kumar Singh , Sharma Deepak K. , Datta Arnab
Published: March 2019

Early current window closure effect has been investigated in ZnO bipolar resistive random access memory cell having reactive contacts (aluminum). From spatial oxygen vacancy mapping through low frequency noise (LFN) measurements, a gradual spatial mismatch between the oxygen vacancy profiles of HRS (high resistance state) and LRS (low resistance state) has been found to develop in the cycled cells. A rate limited release of O2– ions from reactive contacts has been mainly attributed to this phenomenon, which suggests that in addition to the field and temperature as the expected natural impetus for ion migration, chemical reaction at the reactive contacts also impacts the complete dissolution of the conductive filament, which leads to the population of a Zn rich donor state (Zni∙∙/Zni∙) in the HRS of post-cycled cells. Zni∙∙/Zni∙is located relatively far from the ZnO conduction band edge; thus, when an LFN probe was fixed to the oxygen vacancy level (V0∙/V0×), it was found to decrease particularly in the HRS of post-cycled cells, which justifies the increase in the HRS current level over the uncycled ZnO cells. We also examined the complementary behavior of the (V0∙/V0×) profile in the LRS of cycled cells, and finally, we validated, through a different nature of current conduction in pre- and post-cycled cells, the current window narrowing effect due to dissimilarities between the spatial profiles of oxygen vacancies.
High-brightness beam tests of the very high frequency gun at the Advanced Photo-injector EXperiment test facility at the Lawrence Berkeley National Laboratory
Authors: Sannibale F. , Filippetto D. , Qian H. , Mitchell C. , Zhou F. , Vecchione T. , Li R. K. , Gierman S. , Schmerge J.
Published: March 2019

The very-high-frequency gun (VHF-Gun) is a new concept photo-injector developed and built at the Lawrence Berkeley National Laboratory (LBNL) for generating high-brightness electron beams capable of driving X-ray free electron lasers (FELs) at MHz-class repetition rates. The gun that purposely uses established and mature radiofrequency and mechanical technologies has demonstrated over the last many years the capability of reliably operating in continuous wave mode at the design accelerating fields and required vacuum and mechanical performance. The results of VHF-Gun technology demonstration were reported elsewhere [Sannibale et al., Phys. Rev. Spec. Top.-Accel. Beams 15, 103501 (2012)]; here in this paper, we provide and analyze examples of the experimental results of the first high-brightness beam tests performed at the Advanced Photo-injector EXperiment test facility at LBNL that demonstrated the gun capability of delivering the beam quality required for driving high repetition rate X-ray FELs.
Space charge injection behaviors and dielectric characteristics of nano-modified transformer oil using different surface condition electrodes
Authors: Liu Mengna , Yang Qing , Wu Shilin
Published: March 2019

Electrodes are damaged by external forces, mechanical wear, and electrochemical corrosion during long-term operation in power systems, resulting in rough electrode surfaces. Space charge injected into the liquid by a rough electrode under a strong electric field causes electric field distortion and leads to breakdown. Moreover, the charge injection is associated with the energy barrier at the electrode-liquid interface. The combined effect mechanism of nanoparticles and electrode surface condition on the insulating characteristics of transformer oil was investigated using various surface condition aluminum plate electrodes. The breakdown voltages and space charge patterns in pure transformer oil and Al2O3 nano-modified transformer oil under impulse voltage were measured in this study through Kerr electro-optic field mapping measurement. The test results indicate that the breakdown voltage of nano-modified transformer oil depends on voltage polarity and electrode surface conditions and the charge injection shows the same mode in pure transformer oil using different surface condition electrodes, but the magnitude of charge injection differs considerably. Due to nanoparticle’s ability of shielding space charges of different polarities and the charge injection of different surface condition electrodes, they have different effects on the breakdown process of transformer oil between different surface condition electrodes. An interfacial model was formed to explore the mechanism of the effect of nanoparticles and electrode surface conditions on the insulation performance of liquid dielectrics and analyze the breakdown process using the space charge injection behaviors.
Dosimetric accuracy and radiobiological implications of ion computed tomography for proton therapy treatment planning
Authors: Meyer Sebastian , Kamp Florian , Tessonnier Thomas , Mairani Andrea , Belka Claus , Carlson David J , Gianoli Chiara , Parodi Katia
Published: March 2019

Ion computed tomography (iCT) represents a potential replacement for x-ray CT (xCT) in ion therapy treatment planning to reduce range uncertainties, inherent in the semi-empirical conversion of xCT information into relative stopping power (RSP). In this work, we aim to quantify the increase in dosimetric accuracy associated with using proton-, helium- and carbon-CT compared to conventional xCT for clinical scenarios in proton therapy. Three cases imaged with active beam-delivery using an ideal single-particle-tracking detector were investigated using FLUKA Monte-Carlo (MC) simulations. The RSP accuracy of the iCTs was evaluated against the ground truth at similar physical dose. Next, the resulting dosimetric accuracy was investigated by using the RSP images as a patient model in proton therapy treatment planning, in comparison to common uncertainties associated with xCT. Finally, changes in relative biological effectiveness (RBE) with iCT particle type/spectrum were investigated by incorporating the repair-misrepair-fixation (RMF) model into FLUKA, to enable first insights on the associated biological imaging dose. Helium-CT provided the lowest overall RSP error, whereas carbon-CT offered the highest accuracy for bone and proton-CT for soft tissue. For a single field, the average relative proton beam-range variation was  −1.00%, +0.09%, −0.08% and  −0.35% for xCT, proton-, helium- and carbon-CT, respectively. Using a 0.5%/0.5mm gamma-evaluation, all iCTs offered comparable accuracy with a better than 99% passing rate, compared to 83% for xCT. The RMF model predictions for RBE for cell death relative to a diagnostic xCT spectrum were 0.82–0.85, 0.85–0.89 and 0.97–1.03 for proton-, helium-, and carbon-CT, respectively. The corresponding RBE for DNA double-strand break induction was generally below one. iCT offers great clinical potential for proton therapy treatment planning by providing superior dose calculation accuracy as well as lower physical and potentially biological dose exposure compared to xCT. For the investigated dose level and ideal detector, proton-CT and helium-CT yielded the best performance.
Better Virological Outcomes Among People Living With Human Immunodeficiency Virus (HIV) Initiating Early Antiretroviral Treatment (CD4 Counts ≥500 Cells/µL) in the HIV Prevention Trials Network 071 (PopART) Trial in South Africa
Authors: Fatti Geoffrey , Grimwood Ashraf , Nachega Jean B , Nelson Jenna A , LaSorda Kelsea , van Zyl Gert , Grobbelaar Nelis , Ayles Helen , Hayes Richard , Beyers Nulda , Fidler Sarah , Bock Peter
Published: March 2019

Background

There have been concerns about reduced adherence and human immunodeficiency virus (HIV) virological suppression (VS) among clinically well people initiating antiretroviral therapy (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HIV Prevention Trials Network 071 (PopART) trial in South Africa prior to routine national and international implementation.

Methods

This prospective cohort study included adults initiating ART at facilities providing universal ART since January 2014. VS (<400 copies/mL), confirmed virological failure (VF) (2 consecutive viral loads >1000 copies/mL), and viral rebound were compared between participants in strata of baseline CD4 cell count.

Results

The sample included 1901 participants. VS was ≥94% among participants with baseline CD4 count ≥500 cells/µL at all 6-month intervals to 30 months. The risk of an elevated viral load (≥400 copies/mL) was independently lower among participants with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with CD4 count 200–499 cells/µL (9.2%) between months 18 and 30 (adjusted relative risk, 0.30 [95% confidence interval, .12–.74]; P = .010). The incidence rate of VF was 7.0, 2.0, and 0.5 per 100 person-years among participants with baseline CD4 count <200, 200–499, and ≥500 cells/µL, respectively (P < .0001). VF was independently lower among participants with baseline CD4 count ≥500 cells/µL (adjusted hazard ratio [aHR], 0.23; P = .045) and 3-fold higher among those with baseline CD4 count <200 cells/µL (aHR, 3.49; P < .0001).

Conclusions

Despite previous concerns, participants initiating ART with CD4 counts ≥500 cells/µL had very good virological outcomes, being better than those with CD4 counts 200–499 cells/µL.

Clinical Trials Registration

NCT01900977.
Dwindling Utilization of Central Venous Catheter Tip Cultures: An Analysis of Sampling Trends and Clinical Utility at 128 US Hospitals, 2009–2014
Authors: Lai Yi Ling , Adjemian Jennifer , Ricotta Emily E , Mathew Lauren , O’Grady Naomi P , Kadri Sameer S
Published: March 2019

At 128 US hospitals, from 2009–2014, a 17% decline occurred annually in central venous catheter tips sent for culture: a 6-fold decrease from blood culture sampling trends. The positive predictive value was low (23%). Tip culture use often does not conform to recommendations and offers limited independent treatment opportunities.
Building the Framework for Standardized Clinical Laboratory Reporting of Next-generation Sequencing Data for Resistance-associated Mutations in Mycobacterium tuberculosis Complex
Authors: Tornheim Jeffrey A , Starks Angela M , Rodwell Timothy C , Gardy Jennifer L , Walker Timothy M , Cirillo Daniela M , Jayashankar Lakshmi , Miotto Paolo , Zignol Matteo , Schito Marco
Published: March 2019

Tuberculosis is the primary infectious disease killer worldwide, with a growing threat from multidrug-resistant cases. Unfortunately, classic growth-based phenotypic drug susceptibility testing (DST) remains difficult, costly, and time consuming, while current rapid molecular testing options are limited by the diversity of antimicrobial-resistant genotypes that can be detected at once. Next-generation sequencing (NGS) offers the opportunity for rapid, comprehensive DST without the time or cost burden of phenotypic tests and can provide useful information for global surveillance. As access to NGS expands, it will be important to ensure that results are communicated clearly, consistent, comparable between laboratories, and associated with clear guidance on clinical interpretation of results. In this viewpoint article, we summarize 2 expert workshops regarding a standardized report format, focusing on relevant variables, terminology, and required minimal elements for clinical and laboratory reports with a proposed standardized template for clinical reporting NGS results for Mycobacterium tuberculosis.
An Overview of Ethics and Public Health Genetics
Authors: Mathews Debra J. H.
Published: March 2019

Public health genetics (more commonly referred to as “community genetics” in Europe) has been practiced to some degree in the West since at least the 1960s, but the development of a cohesive field took time and advances in technology. The application of genetics and genomics to prevent disease and promote public health became firmly established as a field in the late 1990s, as large-scale sequencing of the human genome as part of the Human Genome Project began. The field is now thriving, leading to both tremendous public health benefits and risks for both individuals and populations. This chapter provides an overview of the section of The Oxford Handbook of Public Health Ethics dedicated to public health genetics. The chapters roughly trace the evolution of public health genetics from its roots in eugenics, to the present challenges faced in newborn screening and biobanking, and finally to emerging questions raised by the application of genomics to infectious disease.
An Overview of Ethics and Environmental Health
Authors: Resnik David B.
Published: March 2019

This chapter provides an overview of the ethics of environmental health, and it introduces five chapters in the related section of The Oxford Handbook of Public Health Ethics. A wide range of ethical issues arises in managing the relationship between human health and the environment, including regulation of toxic substances, air and water pollution, waste management, agriculture, the built environment, occupational health, energy production and use, environmental justice, population control, and climate change. The values at stake in environmental health ethics include those usually mentioned in ethical debates in biomedicine and public health, such as autonomy, social utility, and justice, as well as values that address environmental concerns, such as animal welfare, stewardship of biological resources, and sustainability. Environmental health ethics, therefore, stands at the crossroads of several disciplines, including public health ethics, environmental ethics, biomedical ethics, and business ethics.
An Overview of Public Health Ethics in Emergency Preparedness and Response
Authors: Henry Leslie Meltzer
Published: March 2019

In recent decades, a wide range of abrupt and unpredictable events—including bioterrorism, natural disasters, industrial disasters, and infectious disease outbreaks—have endangered population health and challenged even the most advanced public health and health care systems. Affected populations may face imminent risk to life or health; scarce medical resources; lack of food, water, and shelter; electrical power outages; and interrupted communication. The urgent need to mitigate harms to population health may necessitate rapid decision-making, with incomplete or imperfect information, against a backdrop of political, economic, and social instability. These defining characteristics of public health emergencies are morally significant, not only because they present normatively complex questions about what constitutes an ethical emergency response, but also because they highlight the vital importance of incorporating ethics into public health emergency preparedness.
Pandemic Disease, Public Health, and Ethics
Authors: Smith Maxwell , Upshur Ross
Published: March 2019

Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the spread of disease (e.g., isolation and quarantine), setting priorities for the allocation of scarce resources, health care workers’ duty to care in the face of heightened risk of infection, conducting research during pandemics, and the global governance of preventing and responding to pandemic disease. It also outlines ethical guidance from prominent ethical frameworks that have been developed to address these ethical issues and concludes by discussing some pressing challenges that must be addressed if ethical reflection is to make a meaningful difference in pandemic preparedness and response.
Global Development, Global Public Health, and Ethics
Authors: Bloom Gerald , MacGregor Hayley
Published: March 2019

Rapid development has brought significant economic and health benefits, but it has also exposed populations to new health risks. Public health as a scientific discipline and major government responsibility developed during the nineteenth century to help mitigate these risks. Public health actions need to take into account large inequalities in the benefits and harms associated with development between countries, between social groups, and between generations. This is especially important in the present context of very rapid change. It is important to acknowledge the global nature of the challenges people face and the need to involve countries with different cultures and historical legacies in arriving at consensus on an ethical basis for global cooperation in addressing these challenges. This chapter provides an analysis of these issues, using examples on the management of health risks associated with global development and rapid urbanization and on the emergence of organisms that are resistant to antibiotics.
Modeling and Measuring Deliberation Online
Authors: Beauchamp Nick
Published: March 2019

Online communication is often characterized as dominated by antagonism or groupthink, with little in the way of meaningful interaction or persuasion. This essay examines how one can detect and measure instances of more productive conversation online, considered through the lens of deliberative theory. It begins with an examination of traditional deliberative democracy, then explores how these concepts have been applied to online deliberation and by those studying interpersonal conversation in social media more generally. These efforts to characterize and measure deliberative quality have resulted in a myriad of criteria, with elaborate checklists that are often as superficial as they are complex. This essay instead proposes targeting what is arguably the core deliberative process—a mutual consideration of conceptually interrelated ideas—in order to distinguish the better from the worse and to construct better conceptual structures. The essay finishes by discussing two computational models of argument quality and interdependence as templates for richer, scalable, nonpartisan measures of deliberative discussion online.
Disabilities and Well-Being
Authors: Shepherd Joshua
Published: March 2019

This chapter argues for a normative distinction between disabilities that are inherently negative with respect to well-being and disabilities that are inherently neutral. After clarifying terms, the author discusses recent arguments according to which possession of a disability is inherently neutral with respect to well-being. He notes that although these arguments are compelling, they are only intended to cover certain disabilities and, in fact, that there exists a broad class regarding which they do not apply. He then discusses two problem cases: locked-in syndrome and the minimally conscious state, and explains why these are cases in which possession of these disabilities makes one worse off overall. He argues that disabilities that significantly impair control over one’s situation tend to be inherently negative with respect to well-being; other disabilities do not. The upshot is that we must draw an important normative distinction between disabilities that undermine this kind of control and disabilities that do not.
Neurolinguistics
Authors: Blumstein Sheila
Published: March 2019

The history of research in neurolinguistics has provided an evolving picture of the neural basis of language. This chapter provides a brief review of its historical roots, its theoretical underpinnings that still guide much of current research, what has been learned, and what challenges and questions remain for the future. The field has progressed from a singular focus on the aphasias to the application of a broader palette of methodologies that have revolutionized our ability to map structural and functional properties of the brain. An earlier focus on localization of function has advanced to a recognition that components of the grammar are broadly tuned, recruiting neural systems rather than functionally encapsulated neural regions. Today’s neurolinguistics research promises to provide a deeper understanding of language—its representations, organization, and processes—and the neural systems underlying it—their structure, connections, computations, and intersection with other cognitive domains.
Understanding How We Produce Written Words
Authors: Rapp Brenda , Purcell Jeremy
Published: March 2019

Most of the current understanding of how we produce written language comes from psycholinguistic and cognitive neuropsychological investigations. More recently, both neuroimaging and lesion-based investigations have provided valuable information not only regarding the neural bases of the cognitive processes of written language production, but also regarding key cognitive processes and representations. This chapter focuses on contributions to current understanding of written word production that come from the study of the brain. Four fundamental issues of cognitive representation and processing in spelling are reviewed: the distinction between orthographic long-term and working-memory; the distinction between lexical and sublexical spelling processes; the relationship between reading and spelling; and the role of abstract letter representations in spelling. It specifically highlights the neural findings that have contributed significantly to current understanding of these issues. In some cases, the neural data provide convergence with behavioral findings; in others, they constitute unique contributions. The work reviewed here exemplifies the role of neurolinguistics evidence in furthering understanding of language processing and representation.
Motor Speech Disorders
Authors: Ziegler Wolfram , Schölderle Theresa , Aichert Ingrid , Staiger Anja
Published: March 2019

This chapter reviews speech motor impairments resulting from neurologic disorders, that is, dysarthria and apraxia of speech. The architecture of the brain’s speech motor network is used as a framework to describe the symptom patterns of the most relevant syndromes and their underlying pathomechanisms, with a focus on some of the more controversial issues. The chapter’s final section discusses whether speech motor impairments should be understood as domain-general dysfunctions of respiratory, laryngeal, and vocal tract movements, or as disorders of a motor system specialized for vocal communication.
Neurolinguistic Studies of Patients with Acquired Aphasias
Authors: Wilson Stephen M.
Published: March 2019

The study of patients with acquired aphasias has formed the bedrock of investigations into the neural basis of language for over 150 years. Three main approaches are typically employed. First, patterns of impaired and spared language processes can be carefully characterized in individual patients in order to make inferences about the functional architecture of the normal language system. Second, groups of individuals sharing a clinical syndrome or feature (e.g., Broca’s aphasia, semantic dementia, apraxia of speech) can be investigated so as to better understand the nature of the syndrome or feature, and potentially the role of brain regions associated with it. Third, damaged brain regions can be quantified using magnetic resonance imaging, autopsy, or other methods, and associations can be identified between damage to particular brain regions and resulting language deficits. Inferences can then be made regarding the normal function of these brain regions. There are many challenges to studying patients with acquired aphasias. For instance, lesions are rarely isolated to just a single brain area, and language deficits are rarely isolated to a single language domain or process, making it difficult to disentangle relationships between brain regions and language functions. Furthermore, many patients recover over time and/or may rely on compensatory processes, which can further complicate the interpretation of lesion-deficit relationships. Despite these challenges, studies of patients with acquired aphasias remain crucial to the field of neurolinguistics. Advances in neuroimaging and psycholinguistic assessment are improving researchers’ ability to quantify brain damage and language deficits, respectively, and are leading to new insights into the neural basis of language.
Dyslexia and Its Neurobiological Basis
Authors: Jasińska Kaja , Landi Nicole
Published: March 2019

Skilled reading involves mastery of multiple linguistic (e.g., phonological, semantic, morphological, syntactic) and cognitive processes (e.g., processing speed, attention, working memory). Despite typical levels of intelligence, children with developmental dyslexia (DD) show poor decoding and spelling ability. Given this complexity it is perhaps not surprising that considerable heterogeneity is associated with dyslexia, both in terms of the profile of impairments and genetically, with multiple factors (e.g., genetic, environmental) acting probabilistically in combination to produce a continuum of liability for DD. This chapter reviews neurobiological evidence, including both neuroimaging and genetic studies of reading and reading disorders (including DD) in the context of developmental theories of reading. It describes profiles of perceptual and cognitive performance associated with DD, with relevance to the development of neural systems underlying these reading-related capacities. The chapter also reviews recent contributions from imaging genetic approaches, highlighting relevant gene-brain-behavior connections in reading and DD.
Studying Language with Functional Magnetic Resonance Imaging (fMRI)
Authors: Heim Stefan , Specht Karsten
Published: March 2019

Since the discoveries of language-sensitive brain areas in the late nineteenth century, the localization of the language network in the brain has been the subject of neurolinguistics research. Especially during the times of the two world wars and until the 1980s, head and brain injuries in soldiers as well as in civil patients served as the main data source. The advent of neuroimaging techniques roughly 100 years later was a milestone, providing online data from the living brain. This chapter presents functional magnetic resonance imaging (fMRI) as the most frequently used technique, the physical basics, appropriate experimental study designs, and perspectives for novel developments for neurolinguistics research in the active and passive brain.
Contemporary Life Conduct and Existential Cultures
Authors: Thériault Barbara
Published: March 2019

The concept of lifestyle appears in Max Weber’s writings under the guise of Lebensführung, or life conduct. It is closely linked to the spirit of capitalism and to a religious work ethic Weber traces in life maxims influencing daily practices. Weber is concerned with individual meaning in a world characterized by objective forces. He offers a social diagnosis typical of the beginning of the twentieth century, one centered on the fate of the individual in an increasingly objectified, rationalized, and disenchanted world. Although still pervasive in social theories, this diagnosis framed in terms of loss is at odds with today’s world. While challenging Weber’s diagnosis, this chapter argues that his approach—his notion of life conduct with his attention to life maxims and their carriers—is still inspiring to sound out what Lois Lee calls “existential cultures.” Drawing on Weber’s insights, this chapter maps out life conduct and existential cultures in an east German town.
The Iron Cage in the Information Age
Authors: Raadschelders Jos C. N.
Published: March 2019

The “iron cage” has proven to be a very evocative metaphor, usually associated with government bureaucracy and its regulations. That bureaucracy has become the dominant organizational type in the public, private, and nonprofit sectors is often not recognized. While bureaucracy is often perceived in a negative manner, in a public sector context it also has great benefits, namely in the protection of citizen and societal interests against the private interests of business and lobbying interest groups. What is the role and position of public bureaucracy in contemporary Western, democratic societies? This chapter argues that the state, and by extension its bureaucracy, cannot be hollowed out and supplanted by other types of organization such as enterprise governance and network governance. Has Weber’s worry come true that democracy is marginalized by bureaucratization?