bluuebunny/crossref_metadata_2025 huggingface dataset:
Veränderte intestinale bakterielle Zusammensetzung bei Patienten mit Histaminintoleranz
Authors: Schink Monic , Konturek Peter C. , Tietz Esther , Dieterich Walburga , Neurath Markus F. , Zopf Yurdagül
Published: October 2019

Hintergrund Die Existenz der Histaminintoleranz (HIT) ist umstritten. Als Ursache wird ein gestörter Histaminabbau infolge einer Diaminooxidase(DAO)-Defizienz vermutet. Doch auch andere Faktoren, z. B. eine erhöhte Histaminproduktion durch Darmbakterien, können zu erhöhten Histaminspiegel beitragen. Ziel dieser Untersuchung war es, eine mögliche Veränderung der Darmbakterien in histaminintoleranten Patienten im Vergleich zu gesunden Personen zu detektieren.

Material und Methodik Bei allen Studienprobanden erfolgte die Bestimmung von Gesamt-IgE, nahrungsmittelspezifischen IgEs, TNF-α, Plasmahistamin sowie der Serum-DAO-Aktivität. Anhand von Stuhlproben wurde die Histamin- und Zonulinkonzentration sowie die bakterielle Zusammensetzung mittels 16S-rRNA-Sequenzierung unter Verwendung der Illumina Plattform analysiert.

Ergebnisse Insgesamt 18 Probanden (30,2 ± 12,5 Jahre, 94,4 % weiblich) wurden in die Studie eingeschlossen. Diese umfassten Patienten mit HIT (n = 8; 28,9 ± 11,2 Jahre) und gesunde Kontrollen (n = 10; 31,3 ± 13,9 Jahre). Innerhalb der Studiengruppen wurden keine signifikanten Unterschiede in der Histaminkonzentration im Stuhl festgestellt, wohingegen die HIT-Patienten tendenziell erhöhte Zonulinkonzentration im Stuhl aufwiesen. Die Mikrobiomanalyse zeigte eine erniedrigte bakterielle α-Diversität (p = 0,05) und ein erhöhtes Vorkommen von Proteobacteria in der HIT-Gruppe. Weiterhin wiesen die HIT-Patienten ein signifikant geringeres Vorkommen der Butyrat-produzierenden Bakteriengattungen Faecalibacterium (p = 0,045) und Butyricimonas (p = 0,003) auf. Zudem waren die Anteile an Sutterella (p = 0,043) und Hespellia (p = 0,043) erniedrigt. In keiner Studiengruppe wurden vermehrt histaminproduzierende Bakterien detektiert.

Schlussfolgerung Unsere Ergebnisse deuten auf eine veränderte Darm-Mikrobiota in Patienten mit HIT hin. Der erhöhte Anteil von Proteobacteria und der erniedrigte Anteil an Butyrat-produzierenden Bakterien sowie höhere Zonulinwerte im Stuhl weisen dabei auf eine mögliche Dysbiose oder eine gestörte Darmbarriere hin. Eine erhöhte intestinale Histaminexposition durch Darmbakterien scheint in der Pathogenese der Histaminintoleranz hingegen unwahrscheinlich.
Das Campus-Konzept
Authors: von Eiff Wilfried
Published: October 2019

Das Campus-Konzept ist ein lokal konzentrierter Verbund Sektor übergreifender komplementärer medizinischer Leistungen und versorgt Patienten mit komplexen Krankheitsbildern fallabschließend und ganzheitlich unter Einbezug präventiver, kurativer und rehabilitativer Therapie. Das Campus-Anreizsystem sichert eine hohe Wirtschaftlichkeit im Akutbereich und in der Rehabilitation und verbessert Patienten-Sicherheit sowie Patienten-Outcome.
Diagnostic utility of probe-based confocal laser endomicroscopy in superficial non-ampullary duodenal epithelial tumors
Authors: Tahara Tomomitsu , Horiguchi Noriyuki , Terada Tsuyoshi , Yamada Hyuga , Yoshida Dai , Okubo Masaaki , Funasaka Kohei , Nagasaka Mitsuo , Nakagawa Yoshihito , Tsukamoto Tetsuya , Shibata Tomoyuki , Kuroda Makoto , Ohmiya Naoki
Published: October 2019

Background and study aims Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADETs) has not been established. Probe-based confocal laser endomicroscopy (pCLE: Cellvizio) provides real-time endomicroscopic analysis. We developed and validated a new pCLE classification of SNADET based on abnormal findings.

Patients and methods pCLE scanning of 20 SNADET lesions including 16 adenomas and four carcinomas was retrospectively evaluated to explore abnormal pCLE findings in relation to histological features. Diagnostic yield of pCLE findings was prospectively evaluated in an additional 20 SNADET lesions including 16 adenomas and four carcinomas.

Results In a retrospective study, we identified four abnormal pCLE findings of SNADETs: (1) dark epithelium, (2) columnar cells irregularly extending to the lumen, (3) distorted crypt structure, and (4) fluorescein leakage. Dark epithelium distinguished neoplastic lesions (adenomas and carcinomas) from non-neoplastic duodenal mucosa with a sensitivity of 90 % and a specificity of 100 %. Distorted crypt structure distinguished carcinomas from adenomas and non-neoplastic duodenal mucosa with a sensitivity of 100% and a specificity of 94 %. In the prospective study, the sensitivity and the specificity of the dark epithelium for the diagnosis of neoplastic lesions (adenomas + carcinomas) was 75% and 100 %. Sensitivity and the specificity of the distorted crypt structure for discrimination of carcinoma from adenoma were 100 % and 94 %, respectively.

Conclusions The pCLE findings correlated with the histopathology of the SNADETs. Dark epithelium and distorted crypt structure were informative pCLE findings to predict presence of neoplasia and cancer in the SNADET, respectively.

UMIN-CTR UMIN000013857 TRIAL REGISTRATION: Single-Center, prospective observational trial UMIN000013857 at upload.umin.ac.jp
Toward a conformal field theory for Schramm-Loewner evolutions
Authors: Peltola Eveliina
Published: October 2019

We discuss the partition function point of view for chordal Schramm-Loewner evolutions and their relationship with correlation functions in conformal field theory. Both are closely related to crossing probabilities and interfaces in critical models in two-dimensional statistical mechanics. We gather and supplement previous results with different perspectives, point out remaining difficulties, and suggest directions for future studies.
Hierarchical frequency clusters in adaptive networks of phase oscillators
Authors: Berner Rico , Fialkowski Jan , Kasatkin Dmitry , Nekorkin Vladimir , Yanchuk Serhiy , Schöll Eckehard
Published: October 2019

Adaptive dynamical networks appear in various real-word systems. One of the simplest phenomenological models for investigating basic properties of adaptive networks is the system of coupled phase oscillators with adaptive couplings. In this paper, we investigate the dynamics of this system. We extend recent results on the appearance of hierarchical frequency multiclusters by investigating the effect of the time scale separation. We show that the slow adaptation in comparison with the fast phase dynamics is necessary for the emergence of the multiclusters and their stability. Additionally, we study the role of double antipodal clusters, which appear to be unstable for all considered parameter values. We show that such states can be observed for a relatively long time, i.e., they are metastable. A geometrical explanation for such an effect is based on the emergence of a heteroclinic orbit.
Thermoelastic properties of rare-earth scandates SmScO3, TbScO3 and DyScO3
Authors: Hirschle C. , Schreuer J. , Ganschow S. , Schulze-Jonack I.
Published: October 2019

The elastic properties of rare-earth scandates were only reported at room temperature based on simulations and experimental measurements with poor agreement thus far. Using resonant ultrasound spectroscopy and inductive gauge dilatometry, we determined the elastic stiffnesses, their temperature dependence, and thermal expansion coefficients of SmScO3, TbScO3, and DyScO3 between 103 K and 1673 K. Our set of elastic stiffnesses shows high internal consistency, e.g., the relations c11>c33>c22, c66>c44>c55, and c13≥c12>c23 hold for all crystal species at room temperature. The structures become overall stiffer with decreasing RE-radius and increased charge density. The behavior of c44 at low temperatures indicates in all REScO3 a structural instability that might lead to an orthorhombic→monoclinic transition involving shear of the (100)-plane upon increasing pressure. The transition seems to be promoted by a decreasing RE-radius. Anomalies in two mixed resistances of TbScO3 below room temperature are indicative of at least one more structural instability that may also cause a phase transition where the structure is sheared. So far, only magnetic phase transitions at about 3 K have been observed in REScO3 in literature. The thermoelastic properties in [100] and [001] directions of all materials become increasingly isotropic at high temperatures, suggesting decreased structural tilt. (100) or (010) crystal cuts should be chosen for applications of a REScO3 as a substrate material, when mostly isotropic thermal expansion or longitudinal stiffness in-plane is desired, respectively.
Roughness and amorphization impact on thermal conductivity of nanofilms and nanowires: Making atomistic modeling more realistic
Authors: Verdier Maxime , Lacroix David , Termentzidis Konstantinos
Published: October 2019

In this work, the impact of roughness and amorphization on the effective thermal conductivity of silicon nanofilms and nanowires is studied with atomistic simulations. The discrepancy between simulations and experimental measurements shows that it is necessary to consider realistic roughness and amorphization to reach an agreement. We show that subnanometric roughness and specific correlation length can reduce thermal transport by a factor of two in both nanofilms and nanowires; in addition, this reduction is even more pronounced than the one related to the existence of native oxides or amorphous phases on nanostructure edges. Furthermore, an interfacial thermal resistance parallel to the heat flux is observed. This thermal resistance is increasing upon the increase of the amorphous shell thickness, reaching a maximum value for thickness of 6 nm. Our findings could improve the strategy to elaborate nanomaterials with enhanced thermoelectric efficiency by tuning thermal conductivity through the engineering of surfaces.
I-V characteristics of a piezoelectric semiconductor nanofiber under local tensile/compressive stress
Authors: Huang Haoyu , Qian Zhenghua , Yang Jiashi
Published: October 2019

We study the electrical behavior of a piezoelectric semiconductor fiber under local extensional or compressive stress and an applied voltage. A numerical analysis based on a one-dimensional phenomenological model is performed. The current-voltage relation is obtained. It is found that when the applied voltage is below a stress-dependent critical value, no current can flow through the fiber in either direction. When the voltage is above the critical voltage, currents can flow in one direction but not the other. When the voltage is above a second critical value, currents can flow in both directions. Thus, the local stress acts like a switch, which can turn the currents on and off in one or both directions. This provides a basic means for mechanically manipulating the electrical behavior of piezoelectric semiconductor fibers and thus serves as a fundamental element of piezotronics.
Origami-equivalent compliant mechanism
Authors: Kamrava Soroush , Ghosh Ranajay , Xiong Jian , Felton Samuel M. , Vaziri Ashkan
Published: October 2019

Origami structures have gained tremendous attention due to their extreme kinematic performance. However, typical origami structures suffer from poor load-bearing capacity due to extreme slenderness of facets. In this letter, we introduce a technique to design an origami-equivalent compliant mechanism which preserves the origami kinetics and kinematics while offering higher load-bearing capacity compared to the original origami structure. In this technique, we offer an energy equivalence principle between the origami and the compliant mechanism. We validate the principle using experimental investigation for a square-twist origami pattern. This principle thus opens up a significant avenue for designing deployable and programmable structures.
Demonstration of a superconducting nanowire microwave switch
Authors: Wagner A. , Ranzani L. , Ribeill G. , Ohki T. A.
Published: October 2019

The functionality of a nanowire integrated into a superconducting transmission line acting as a single pole single throw switch is demonstrated. The switch has an instantaneous bandwidth from 2 to 8 GHz with more than 10 dB of isolation between the open and closed states. The switch consumes no power in the closed state and ≈15 nW in the open state. The rise and fall response time between open and closed states is approximately 370 ps.
Spatially dependent four-wave mixing in semiconductor quantum wells
Authors: Zhang Yufeng , Wang Zhiping , Qiu Jing , Hong Yin , Yu Benli
Published: October 2019

We propose a scheme to generate spatially dependent four-wave mixing (FWM) in an asymmetric semiconductor three-coupled-quantum-well nanostructure. By adjusting the detuning of the control field, one can effectively manipulate the FWM output field. Specifically, the vortex phase of the FWM field can be modulated. The detailed explanations based on the dispersion relation are given, which are in good agreement with our results. Furthermore, we perform the interference between the FWM field and the same-frequency Gaussian beam. Our results show that the interference patterns can also be modulated via the detuning of the control field, which may provide a way to observe helical phase modulation via the intensity measurement. This work may be useful for investigating the nonlinear optical phenomena based on orbital angular momentum light.
Investigation of nitrogen polar p-type doped GaN/AlxGa(1-x)N superlattices for applications in wide-bandgap p-type field effect transistors
Authors: Krishna Athith , Raj Aditya , Hatui Nirupam , Keller Stacia , Mishra Umesh K.
Published: October 2019

In this study, the metal-organic chemical vapor deposition growth and electrical properties of N-polar modulation doped p-AlGaN/GaN superlattices (SLs) were investigated. Hole sheet charge density and mobility were studied as a function of the concentration of the p-type dopant Mg in the SL and the number of SL periods. Room temperature Hall measurements were carried out to determine the hole mobility and the sheet charge density. While the hole density increased with the increasing number of SL periods, the hole mobility was largely unaffected. Hole mobilities as high as 18 cm2/V s at a simultaneously high hole density of 6.5 × 1013 cm−2 were observed for N-polar SLs with a Mg modulation doping of 7.5 × 1018 cm−3. For comparable uniformly doped Ga-polar SL samples, a mobility of 11 cm2/V s was measured. These results confirm the presence of abrupt Mg doping profiles in N-polar p-type GaN/AlxGa(1−x)N SL, allowing the demonstration of SLs with properties comparable to those of state-of-the-art Ga-polar modulation doped AlGaN/GaN SLs grown using molecular beam epitaxy. The lowest sheet resistance in the GaN/AlGaN material system of 5 kΩ/◻ is also reported. Test-structure transistors were also fabricated to investigate the applicability of these SL structures, with the planar device resulting in a current of 5 mA/mm and a FinFET structure resulting in a current of over 100 mA/mm.
Amino Acid and Secondary Structure Integrity of Sonicated Milk Proteins
Authors: Pathak Rachana , Leong Thomas S. H. , Martin Gregory J. O. , Ashokkumar Muthupandian
Published: October 2019

This study investigated the effect of low-frequency (20kHz) and high-frequency (414kHz) ultrasound treatment on the amino acid and secondary structural integrity of dairy proteins. Sonicated skim milk proteins were hydrolysed and analysed with reverse-phase high-performance liquid chromatography to investigate the amino acid content of the processed samples. It was successfully demonstrated that both low-frequency and high-frequency ultrasound did not adversely affect the amino acid content, even after prolonged extreme processing conditions (6h, 355kHz). This finding was supplemented with protein secondary structure data (Fourier-transform (FT)-IR secondary derivatives of the amide I band, 1700–1600cm−1) that showed that ultrasound was capable of causing structural modifications to the dairy proteins. This study shows that ultrasound can be used to influence protein–protein interactions in skim milk via alterations to the secondary structure without degrading the amino acids in the proteins.
Concussion, Sensation-Seeking and Substance use among US Adolescents
Authors: Veliz Phil , McCabe Sean Esteban , Eckner James T. , Schulenberg John E.
Published: October 2019

Background

No large-scale epidemiological survey of adolescents in the US has assessed the association between lifetime history of concussion, propensity toward sensation-seeking, and recent substance use.

Methods

This study assesses the association between lifetime history of diagnosed concussions, sensation-seeking, and recent substance use (i.e., cigarette use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) using the 2016 and 2017 Monitoring the Future study of 25,408 8th, 10th, and 12th graders.

Results

Lifetime diagnosis of concussion was associated with greater odds of past 30-day/2-week substance use. Adolescents who indicated multiple diagnosed concussions (versus none) had two times greater odds of all types of recent substance use, after adjusting for potential confounding factors. Adolescents indicating multiple diagnosed concussions also had higher adjusted odds of cigarette use, binge drinking, and marijuana use) when compared to adolescents who only indicated one diagnosed concussion. Accounting for adolescents’ propensity toward sensation-seeking did not significantly change the association between substance use and multiple diagnosed concussions.

Conclusions

This study provides needed epidemiological data regarding concussion and substance use among US adolescents. Exposure to a single diagnosed concussion is associated with a modest increase in the risk of substance use and this association increases with the accumulation of multiple diagnosed concussions. These associations hold when controlling for sensation-seeking. Substance use prevention efforts should be directed toward adolescents who have a history of multiple concussions.
Understanding why Patients with Substance use Disorders Leave the Hospital against Medical Advice: A Qualitative Study
Authors: Simon Rachel , Snow Rachel , Wakeman Sarah
Published: October 2019

Background

Hospital discharges against medical advice (AMA) is associated with negative health outcomes and re-admissions. Patients with substance use disorders (SUD) are up to three times more likely to be discharged AMA as compared to those without SUD. Studies suggest that undertreated withdrawal and a perception of stigma may increase the risk, however, to date, there are no published qualitative studies exploring the specific reasons why patients with SUD leave prematurely.

Methods

Semi-structured interviews with patients ( n = 15) with SUD with documented AMA discharges from our hospital between 9/2017 and 9/2018. Maximum variation sampling was employed to display diversity across gender, race, age, and type of substance use disorder (alcohol vs opioids). Patients were interviewed until no new concepts emerged from additional interviews. Two coders separately coded all transcripts and reconciled code assignments.

Results

Four core issues were identified as patients’ reasons for leaving the hospital prematurely: undertreated withdrawal and ongoing craving to use drugs, uncontrolled acute and chronic pain, stigma and discrimination by hospital staff about their SUD, and hospital restrictions, including not being allowed to intermittently leave the hospital floor. For patients with histories of criminal involvement, being hospitalized reminded them of being incarcerated.

Conclusion

These findings shed light on the reasons patients with SUD are discharged from the hospital AMA, an event that is associated with increased thirty-day mortality and hospital re-admission. AMA discharges represent missed opportunities for the health care system to engage with patients struggling with a SUD. Our findings support the need for inpatient addiction treatment, particularly for management of withdrawal and co-occurring pain, and the need to address health care provider associated stigma surrounding addiction.
Impact of the Take ACTION Train-The-Trainer Model of Opioid Overdose Education with Naloxone Distribution– who Benefits?
Authors: Dahlem C. H. , Scalera M. , Chen B. , McCabe S. E. , Boyd C. J.
Published: October 2019

Background

Overdose education with naloxone distribution (OEND) is a key national strategy to reduce morbidity and mortality related to opioid overdoses. Train-the-trainer model has been one method to increase the pool of trainers to facilitate greater dissemination of OEND. This exploratory study seeks to (1) evaluate participant's change in knowledge and confidence, (2) examine if pre- and post-training test outcomes differed by occupation and level of experience, and (3) determine if train-the-trainer participants trained others 6 months later.

Methods

Fifteen train-the-trainer sessions were delivered to staff from community organizations who served high-risk clients in four counties whose overdose death rates ranged from 11.2 to 32.8 per 100,000. Participants were administered pre- and post-training tests from September 2017 to December 2018. A follow-up survey was conducted 6 months post-training to evaluate outcomes. Final paired pre-and post-training surveys of 109 participants were used for analysis. Paired sample t-tests were used to evaluate changes in the knowledge and confidence in teaching others. One-way ANOVA compared the change scores across groups with different demographic or experiential characteristics. Kruskal-Wallis Test was used for Likert scales.

Results

The one and one-half hour train-the-trainer curriculum increased participants’ knowledge and confidence to teach others ( p < .001). This was particularly true for participants who had no prior experience compared to those who had some experience with naloxone ( p = .0003). Changes in confidence to teach others significantly improved among demographic subgroups of participants. At 6 months after completing the train-the-trainer curriculum, 14 participants had trained 243 new trainees.

Conclusions

Implementing a train-the-trainer model for OEND increases knowledge and participants’ confidence to teach others. This demonstrates the important potential of the train-the-trainer model to respond to the growing opioid overdose epidemic.
Effectiveness of Music Therapy on Improving Treatment Motivation and Emotion in Female Patients with Methamphetamine Use Disorder: A Randomized Controlled Trial
Authors: Wu Qianying , Chen Tianzhen , Wang Zhe , Chen Shujuan , Zhang Jingying , Bao Jiayi , Su Hang , Tan Haoye , Jiang Haifeng , Du Jiang , Zhao Min
Published: October 2019

Objectives

The purpose of the study was to investigate whether Group Music Therapy (GMT) could enhance the treatment motivation and change the negative emotion among female patients with methamphetamine use disorder in a randomized clinical trial.

Methods

Participants ( N = 60) were randomized to the group of GMT combined with treatment as usual (TAU) or the group with TAU only. Questionnaire of Motivation for Abstaining from Drugs was used to measure the motivation for abstaining from drugs of the female patients. And Self-Rating Depression Scale and Self-Rating Anxiety Scale were used to measure negative emotion of participants. The measurements were conducted at T0 (baseline), T1 (post 13 sessions of intervention) and T2 (3-month follow-up after T1) by the independent trained researcher.

Results

The postintervention and 3-month follow-up results according to the intention-to-treat principle indicated that GMT + TAU intervention showed significantly positive group-by-time effect on the scores of the subscale-tending to rehabilitation-internal motivation ( p = 0.01) and avoiding abuse-external motivation ( p = 0.04). In 3-month follow-up, total scores of the questionnaire of motivation for abstaining from drugs ( p = 0.02), scores of avoiding abuse-internal motivation subscale ( p = 0.05), and scores of confidence of abstaining from drugs subscale ( p = 0.01) in GMT + TAU were also presented with significantly positive group x time effect. The changes of total score of Questionnaire of Motivation for Abstaining from Drugs (from baseline to 3-month follow-up) was significantly positive association with the changes of scores of SAS in GMT + TAU group ( r = −0.55, p = 0.00).

Conclusions

The present study suggests that GMT could be used as an effective treatment strategy to enhance treatment motivation of female patients with methamphetamine use disorder.
Specific energy cost for nitrogen fixation as NOx using DC glow discharge in air
Authors: Pei Xuekai , Gidon Dogan , Graves David B
Published: October 2019

We report on factors influencing the specific energy costs of producing NO
x
from pin-to-pin DC glow discharges in air at atmospheric pressure. Discharge current, gap distance, gas flowrate, exterior tube wall temperature and the presence and position of activated Al2O3 catalyst powder were examined. The presence of heated catalyst adjacent to the plasma zone improved energy efficiency by as much as 20% at low flows, but the most energy efficient conditions were found at the highest flowrates that allowed a stable discharge (about 10–15 l min−1). Under these conditions, the catalyst had no effect on efficiency in the present study. The lowest specific energy cost was observed to be between about 200–250 GJ/tN. The transport of active chemical species and energy are likely key factors controlling the specific energy costs of NO
x
production in the presence of a catalyst. Air plasma device design and operating conditions must ensure that plasma-generated active intermediate chemical species transport is optimally coupled with catalytically active surfaces.
Palm seed and fruit lipid composition: phylogenetic and ecological perspectives
Authors: Guerin Chloé , Serret Julien , Montúfar Rommel , Vaissayre Virginie , Bastos-Siqueira Aldecinei , Durand-Gasselin Tristan , Tregear James , Morcillo Fabienne , Dussert Stéphane
Published: October 2019

Background and aims

Palms are vital to worldwide human nutrition, in particular as major sources of vegetable oils. However, our knowledge of seed and fruit lipid diversity in the family Arecaceae is limited. We therefore aimed to explore relationships between seed and fruit lipid content, fatty acid composition in the respective tissues, phylogenetic factors and biogeographical parameters.

Methods

Oil content and fatty acid composition were characterized in seeds and fruits of 174 and 144 palm species respectively. Distribution, linear regression and multivariate analyses allowed an evaluation of the chemotaxonomic value of these traits and their potential relationship with ecological factors.

Key Results

A considerable intra-family diversity for lipid traits was revealed. Species with the most lipid-rich seeds belonged to the tribe Cocoseae, while species accumulating oil in the mesocarp occurred in all subfamilies and two-thirds of the tribes studied. Seed and fruit lipid contents were not correlated. Fatty acid composition of mesocarp oil was highly variable within tribes. By contrast, within-tribe diversity for seed lipid traits was low, whereas between-tribe variability was high. Consequently, multivariate analyses of seed lipid traits produced groupings of species belonging to the same tribe. Medium-chain fatty acids predominated in seeds of most palm species, but they were also accumulated in the mesocarp in some cases. Seed unsaturated fatty acid content correlated with temperature at the coldest latitude of natural occurrence.

Conclusion

Several previously uncharacterized palms were identified as potential new sources of vegetable oils for comestible or non-food use. Seed lipid traits reflect genetic drift that occurred during the radiation of the family and therefore are highly relevant to palm chemotaxonomy. Our data also suggest that seed unsaturated fatty acids may provide an adaptive advantage in the coldest environments colonized by palms by maintaining storage lipids in liquid form for efficient mobilization during germination.
The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies
Authors: Albright William B , Hawkes Patrick J
Published: October 2019

Background

As immediate direct to permanent implant-based breast reconstruction (IBBR) continues to gain in popularity, surgeons seek to apply these techniques to patients with large or ptotic breasts. A new bell pattern skin excision is described and limits major complications in this high-risk population.

Objective

The authors describe a novel skin excision pattern for patients with large or ptotic breasts who desire IBBR and assess its safety. The authors also evaluated the ability of the pattern to account for intraoperative developments.

Methods

This retrospective analysis of a single surgeon’s experience included 17 consecutive patients (31 breasts) with large or ptotic breasts undergoing skin-reducing mastectomy with attempted utilization of the bell pattern approach and IBBR with acellular dermal matrix.

Results

Mean age was 50 years, mean body mass index was 27.4 kg/m2, and mean breast specimen weight was 683 g. A bell pattern excision was planned for all breasts preoperatively. Three breasts (10%) required an alternative closure pattern due to intraoperative ischemia (n = 1), or additional oncologic resection (n = 2). The pattern successfully accommodated flap ischemia in 8 (26%) other breasts. After a median follow-up of 5.1 months, the number of bell pattern breasts with major and minor complications was 0 (0%) and 9 (32%), respectively. The most common minor complication was seroma (n = 5, 18%), and minor incision wound (n = 3, 11%). There were no reconstruction failures utilizing the bell pattern.

Conclusion

The bell pattern approach is a safe and adaptable alternative to traditional skin-reducing mastectomy in patients with large or ptotic breasts.

Level of Evidence: 4
Constitution Making in Asia
Authors: Saunders Cheryl
Published: October 2019

This short article is an introduction to a Symposium on Constitution Making in Asia and the Pacific. It seeks to place constitution making in Asia in the context of the broader global debate. In doing so, it develops the theme of the relationship between the local and the global in constitution-making projects. It suggests four sets of factors that deserve consideration in examining the relationship between local and global influences: ownership, implementation, accountability, and legitimacy. A final section reflects on the experiences of constitution making in Asia and the Pacific and the way in which these factors play out in the various case studies.
Clinical review on triglycerides
Authors: Laufs Ulrich , Parhofer Klaus G , Ginsberg Henry N , Hegele Robert A
Published: October 2019

Hypertriglyceridaemia is a common clinical problem. Epidemiologic and genetic studies have established that triglyceride-rich lipoproteins (TRL) and their remnants as important contributors to ASCVD while severe hypertriglyceridaemia raises risk of pancreatitis. While low-density lipoprotein is the primary treatment target for lipid lowering therapy, secondary targets that reflect the contribution of TRL such as apoB and non-HDL-C are recommended in the current guidelines. Reduction of severely elevated triglycerides is important to avert or reduce the risk of pancreatitis. Here we discuss interventions for hypertriglyceridaemia, including diet and lifestyle, established treatments such as fibrates and omega-3 fatty acid preparations and emerging therapies, including various biological agents.
Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EORP Atrial Fibrillation Ablation Long-Term and Atrial Fibrillation General Pilot Registries
Authors: Tilz Roland Richard , Dagres Nikolaos , Arbelo Elena , Blomström-Lundqvist Carina , Crijns Harry J , Kirchhof Paulus , Kautzner Josef , Temporelli Pier Luigi , Laroche Cécile , Roberts Paul R , Pehrson Steen , Lip Gregory Y H , Brugada Josep , Tavazzi Luigi ,   the Atrial Fibrillation Ablation and Atrial Fibrillation Registries Investigators Groups
Published: October 2019

Aims

Rhythm control management in patients with atrial fibrillation (AF) may be unequal across Europe. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection.

Methods and results

Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC EORP AFA-LT) registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC EORP AF-Gen) pilot registry. Data collection was performed using a web-based system. In the AFA and in the Atrial Fibrillation General (AFG) pilot registries, 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger, more commonly male, and had significantly less comorbidities. Atrial Fibrillation Ablation patients often presented without comorbidities, resulting in a lower risk of stroke (CHA2DS2-VASc ≥5: 2.9% vs. 24.5%, all P < 0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P < 0.001) but with European Heart Rhythm Association (EHRA) scores >1 and more prevalent AF-related symptoms such as palpitations, fatigue, and weakness (all P < 0.001) as compared to the general AF patients. Atrial Fibrillation Ablation patients were significantly more often male, had higher left ventricular ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P < 0.001 each).

Conclusion

The comparison of the patient cohorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and relatively healthy patients.
Urinary incontinence in women: treatment barriers and significance for Danish and German GPs
Authors: Elsner Susanne , Juergensen Martina , Faust Elke , Niesel Achim , Pedersen Louise Schreiber , Rudnicki Peter Martin , Waldmann Annika
Published: October 2019

Background

Female urinary incontinence (UI) is common. Only scant information exists on the significance of UI for GPs’ consultations.

Objectives

(i) To assess the significance of female UI for GPs and to look at barriers that could be detrimental to treatment by comparing GPs from Denmark and Germany, with different health systems and access to UI guidelines. (ii) To assess whether GPs’ gender and age were relevant to the discussion of UI.

Methods

We conducted a cross-sectional survey. In the Fehmarn belt-region, a Danish–German border region, a self-developed questionnaire was sent to all the GPs (n = 930).

Results

In total, 407 GPs returned the questionnaire (43%); 403 questionnaires were analysed. Using a scale from 0 (never) to 10 (always), addressing UI was reported with an average score of 3.8 (SD: 2.1) among Danish and 3.5 (SD: 2.1) among German GPs. The topic was discussed more frequently with female (4.2; SD 2.2) than with male GPs (3.2; SD 2.0). Danish GPs estimated the prevalence among their female patients at 10% (SD: 8.0) and German GPs at 14% (SD: 11.2). 61% of the Danish and 19% of the German GPs used UI guidelines. German GPs significantly more often reported the barrier ‘uncertainty of how to treat UI’ [OR = 5.39 (95% CI: 2.8; 10.4)].

Conclusions

In consultations with female GPs, UI was discussed significantly more frequently than with male GPs. Compared with the Danish GPs, German GPs stated significantly more uncertainties regarding UI treatment measures, and tended not to use UI guidelines.
FRAND licensing and implementation chains
Authors: Kühnen Thomas
Published: October 2019

It is conventional wisdom that the proprietors of standard-essential patents (“SEPs”) are free to choose the implementation stage at which they offer FRAND licenses for their inventions; ordinarily, these proprietors offer licenses to the actors at the end of the implementation chain, because the consumer goods incorporating patented technology, considering their high sales price, promise the putatively highest licensing fees. The patent users upstream from the licensee are denied their own FRAND license on the grounds that they are sufficiently protected against patent infringement actions by virtue of the licenses granted to their buyers. The present article will show that both assumptions are incorrect. First, every interested party has a claim to a license absent any special prerequisites; hence, the party at the beginning of the implementation chain, too, has such a claim, even if a FRAND license has already been granted at the distribution stage downstream from said party. Second, the amount of a FRAND royalty will not depend on the position of the license applicant within the implementation chain.
Pragmatic Health Assessment in Early Childhood: The PROMIS® of Developmentally Based Measurement for Pediatric Psychology
Authors: Blackwell Courtney K , Wakschlag Lauren , Krogh-Jespersen Sheila , Buss Kristin A , Luby Joan , Bevans Katherine , Lai Jin-Shei , Forrest Christopher B , Cella David
Published: October 2019

Objective

To illustrate the integration of developmental considerations into person-reported outcome (PRO) measurement development for application in early childhood pediatric psychology.

Methods

Combining the state-of-the-science Patient-Reported Outcome Measurement Information System (PROMIS®) mixed-methods instrument development approach with considerations from developmental measurement science, we developed 12 PROMIS early childhood (PROMIS EC) parent report measures to evaluate common mental, social, and physical health outcomes for ages 1–5. Through this interdisciplinary effort, we identified key considerations for early childhood PROs that enable reliable and valid assessment within the real-world constraints of clinical care settings.

Results

Four key considerations are highlighted as key to this process: (a) Engage diverse content experts to identify meaningful and relevant constructs; (b) Balance salient features for early childhood with lifespan coherence of constructs; (c) Emphasize observable features across the typical/atypical spectrum; and (d) Ensure feasibility and relevancy for clinical and research application. Each consideration is discussed using exemplars from the PROMIS EC measurement development process.

Conclusions

PROMIS EC provides an illustration of how well-established PRO measures for youth can be adapted for younger children by incorporating developmental considerations. This process and resulting key considerations provide clinicians and researchers in the field of pediatric psychology with guidance for adapting PROs to early childhood, enabling critical continuity in domains of high salience to pediatric psychologists.
Evisceration Versus Enucleation Following Ocular Trauma, a Retrospective Analysis at a Level One Trauma Center
Authors: Reed Donovan , Papp Alexandra , Brundridge Wesley , Mehta Aditya , Santamaria Joseph , Valentin Frank , Davies Brett
Published: October 2019

Introduction

Penetrating and perforating ocular trauma is often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. Enucleation is commonly utilized for management of a non-salvageable eye following penetrating and perforating ocular injuries. Recently, the use of evisceration for non-salvageable traumatized eyes has increased. As a technically easier alternative, evisceration offers several advantages to the ocular trauma surgeon to include faster surgical times, better cosmesis and motility, and improved patient outcomes. Debate still persists concerning whether or not evisceration is a viable option in the surgical management of a non-salvageable eye following ocular trauma given the theoretical increased risk of sympathetic ophthalmia and technical difficulty in construction of the scleral shell with extensive and complex corneoscleral lacerations. A retrospective analysis at a level 1 trauma center was performed to evaluate the practicality of evisceration in ocular trauma.

Materials and Methods

Eyes that underwent evisceration or enucleation following ocular trauma at San Antonio Military Medical Center, a level 1 trauma center, between 01 January 2014 and 30 December 2016 were examined. Factors evaluated include mechanism of injury, defect complexity, ocular trauma score, and time from injury to surgical intervention. Surgical outcomes were assessed.

Results

In total, 29 eyes were examined, 15 having undergone evisceration and 14 enucleation. The average size of the scleral defect before evisceration was 20 mm in length, and 23 mm before enucleation. The mechanism of injury and characterization of the defects among the two groups were relatively similar and described. Overall comparison of the two study groups in terms of surgical outcomes and complications was also relatively similar, as demonstrated. No cases of postoperative persistent pain, sympathetic ophthalmia, infection, or hematoma were identified for either group.

Conclusions

The postoperative outcomes demonstrated for the evisceration group are comparable to enucleation, which is consistent with the recent literature. Defect size and complexity did not affect surgical construction of the scleral shell during evisceration. If consistently proven to be a safe and viable alternative to enucleation, evisceration can offer shorter surgical times and better cosmesis for patients. More research into the long-term complication rates and more cases of evisceration for use following ocular trauma should be assessed. Still, this analysis demonstrates that evisceration is a viable surgical alternative and perhaps superior to enucleation for the management of a non-salvageable eye following extensive ocular trauma in many cases.
How AGN feedback drives the size growth of the first quasars
Authors: van der Vlugt Dieuwertje , Costa Tiago
Published: October 2019

Quasars at $z = 6$ are powered by accretion on to supermassive black holes with masses $M_{\rm BH} \sim 10^9 \rm \, M_{\odot}$. Their rapid assembly requires efficient gas inflow into the galactic nucleus, sustaining black hole accretion at a rate close to the Eddington limit, but also high central star formation rates. Using a set of cosmological ‘zoom-in’ hydrodynamic simulations performed with the moving mesh code Arepo, we show that $z = 6$ quasar host galaxies develop extremely tightly bound stellar bulges with peak circular velocities $300\!-\!500 \, \rm km \, s^{-1}$ and half-mass radii ${\approx}0.5 \, \rm kpc$. Despite their high binding energy, we find that these compact bulges expand at $z \, \lt \, 6$, with their half-mass radii reaching ${\approx}5 \, \rm kpc$ by $z = 3$. The circular velocity drops by factors of ≈2 from their initial values to $200\!-\!300 \, \rm km \, s^{-1}$ at $z \, \approx \, 3$ and the stellar profile undergoes a cusp-core transformation. By tracking individual stellar populations, we find that the gradual expansion of the stellar component is mainly driven by fluctuations in the gravitational potential induced by bursty AGN feedback. We also find that galaxy size growth and the development of a cored stellar profile does not occur if AGN feedback is ineffective. Our findings suggest that AGN-driven outflows may have profound implications for the internal structure of massive galaxies, possibly accounting for their size growth, the formation of cored ellipticals as well as for the saturation of the MBH–σ⋆ seen at high-velocity dispersions σ⋆.
Exploring suppressed long-distance correlations as the cause of suppressed large-angle correlations
Authors: Copi Craig J , Gurian James , Kosowsky Arthur , Starkman Glenn D , Zhang Hezi
Published: October 2019

The absence of large-angle correlations in the map of cosmic microwave background temperature fluctuations is among the well-established anomalies identified in full-sky and cut-sky maps over the past three decades. Suppressed large-angle correlations are rare statistical flukes in standard inflationary cosmological models. One natural explanation could be that the underlying primordial density perturbations lack correlations on large distance scales. To test this idea, we replace Fourier modes by a wavelet basis with compact spatial support. While the angular correlation function of perturbations can readily be suppressed, the observed monopole- and dipole-subtracted correlation function is not generally suppressed. This suggests that suppression of large-angle temperature correlations requires a mechanism that has both real-space and harmonic-space effects.
Joint radio and X-ray modelling of PSR J1136+1551
Authors: Pétri J , Mitra D
Published: October 2019

Multiwavelength observations of pulsar emission properties are powerful means to constrain their magnetospheric activity and magnetic topology. Usually a star centred magnetic dipole model is invoked to explain the main characteristics of this radiation. However, in some particular pulsars where observational constraints exist, such simplified models are unable to predict salient features of their multiwavelength emission. This paper aims to carefully model the radio and X-ray emission of PSR J1136+1551 with an off-centred magnetic dipole to reconcile both wavelength measurements. We simultaneously fit the radio pulse profile with its polarization and the thermal X-ray emission from the polar cap hotspots of PSR J1136+1551. We are able to pin down the parameters of the non-dipolar geometry (which we have assumed to be an offset dipole) and the viewing angle, meanwhile accounting for the time lag between X-ray and radio emission. Our model fits the data if the off-centred magnetic dipole lies about 20 per cent below the neutron star surface. We also expect very asymmetric polar cap shapes and sizes, implying non-antipodal and non-identical thermal emission from the hotspots. We conclude that a non-dipolar surface magnetic field is an essential feature to explain the multiwavelength aspects of PSR J1136+1551 and other similar pulsars.
Coupling 1D stellar evolution with 3D-hydrodynamical simulations on-the-fly II: stellar evolution and asteroseismic applications
Authors: Mosumgaard Jakob Rørsted , Jørgensen Andreas Christ Sølvsten , Weiss Achim , Silva Aguirre Víctor , Christensen-Dalsgaard Jørgen
Published: October 2019

Models of stellar structure and evolution are an indispensable tool in astrophysics, yet they are known to incorrectly reproduce the outer convective layers of stars. In the first paper of this series, we presented a novel procedure to include the mean structure of 3D hydrodynamical simulations on-the-fly in stellar models, and found it to significantly improve the outer stratification and oscillation frequencies of a standard solar model. In this work, we extend the analysis of the method; specifically how the transition point between envelope and interior affects the models. We confirm the versatility of our method by successfully repeating the entire procedure for a different grid of 3D hydrosimulations. Furthermore, the applicability of the procedure was investigated across the HR diagram and an accuracy comparable to the solar case was found. Moreover, we explored the implications on stellar evolution and find that the red-giant branch is shifted about $40\, \mathrm{K}$ to higher effective temperatures. Finally, we present for the first time an asteroseismic analysis based on stellar models fully utilizing the stratification of 3D simulations on-the-fly. These new models significantly reduce the asteroseismic surface term for the two selected stars in the Kepler field. We extend the analysis to red giants and characterize the shape of the surface effect in this regime. Lastly, we stress that the interpolation required by our method would benefit from new 3D simulations, resulting in a finer sampling of the grid.