Assessment of Metal Immission in Urban Environments Using Elemental Concentrations and Zinc Isotope Signatures in Leaves of Nerium oleander

A thorough understanding of spatial and temporal emission and immission patterns of air pollutants in urban areas is challenged by the low number of air-quality monitoring stations available. Plants are promising low-cost biomonitoring tools. However, source identification of the trace metals incorporated in plant tissues (i.e., natural vs anthropogenic) and the identification of the best plant to use remain fundamental challenges. To this end, Nerium oleander L. collected in the city of Zaragoza (NE Spain) has been investigated as a biomonitoring tool for assessing the spatial immission patterns of airborne metals (Pb, Cu, Cr, Ni, Ce, and Zn). N. oleander leaves were sampled at 118 locations across the city, including the city center, industrial hotspots, ring-roads, and outskirts. Metal concentrations were generally higher within a 4 km radius around the city center. Calculated enrichment factors relative to upper continental crust suggest an anthropogenic origin for Cr, Cu, Ni, Pb, and Zn. Zinc isotopes showed significant variability that likely reflects different pollution sources. Plants closer to industrial hotspots showed heavier isotopic compositions (δ⁶⁶Zn_Lyon up to +0.70‰), indicating significant contributions of fly ash particles, while those far away were isotopically light (up to -0.95‰), indicating significant contributions from exhaust emissions and flue gas. We suggest that this information is applied for improving the environmental and human risk assessment related to the exposure to air pollution in urban areas.

Clinical Decision Support System for Point of Care Use

Objectives: The objective of this research was to design a clinical decision support system (CDSS) that supports heterogeneous clinical decision problems and runs on multiple computing platforms. Meeting this objective required a novel design to create an extendable and easy to maintain clinical CDSS for point of care support. The proposed solution was evaluated in a proof of concept implementation.

Methods: Based on our earlier research with the design of a mobile CDSS for emergency triage we used ontology-driven design to represent essential components of a CDSS. Models of clinical decision problems were derived from the ontology and they were processed into executable applications during runtime. This allowed scaling applications’ functionality to the capabilities of computing platforms. A prototype of the system was implemented using the extended client-server architecture and Web services to distribute the functions of the system and to make it operational in limited connectivity conditions.

Results: The proposed design provided a common framework that facilitated development of diversified clinical applications running seamlessly on a variety of computing platforms. It was prototyped for two clinical decision problems and settings (triage of acute pain in the emergency department and postoperative management of radical pros-tatectomy on the hospital ward) and implemented on two computing platforms – desktop and handheld computers.

Conclusions: The requirement of the CDSS heterogeneity was satisfied with ontology-driven design. Processing of application models described with the help of ontological models allowed having a complex system running on multiple computing platforms with different capabilities. Finally, separation of models and runtime components contributed to improved extensibility and maintainability of the system.

Technological innovations and the rise of social inequalities in health

Social inequalities in health have been categorised as a human-rights issue that requires action. Unfortunately, these inequalities are on the rise in many countries, including welfare states. Various theories have been offered to explain the persistence (and rise) of these inequalities over time, including the social determinants of health and fundamental cause theory. Interestingly, the rise of modern social inequalities in health has come at a time of great technological innovation. This article addresses whether these technological innovations are significantly influencing the persistence of modern social inequalities in health. A theoretical argument is offered for this potential connection and is discussed alongside the typical social determinants of health perspective and the increasingly popular fundamental cause perspective. This is followed by a proposed research agenda for further investigation of the potential role that technological innovations may play in influencing social inequalities in health.

Gate-tunable large magnetoresistance in an all-semiconductor spin valve device

A large spin-dependent and electric field-tunable magnetoresistance of a two-dimensional electron system is a key ingredient for the realization of many novel concepts for spin-based electronic devices. The low magnetoresistance observed during the last few decades in devices with lateral semiconducting transport channels between ferromagnetic source and drain contacts has been the main obstacle for realizing spin field effect transistor proposals. Here, we show both a large two-terminal magnetoresistance in a lateral spin valve device with a two-dimensional channel, with up to 80% resistance change, and tunability of the magnetoresistance by an electric gate. The enhanced magnetoresistance is due to finite electric field effects at the contact interface, which boost spin-to-charge conversion. The gating scheme that we use is based on switching between uni- and bidirectional spin diffusion, without resorting to spin-orbit coupling. Therefore, it can also be employed in materials with low spin-orbit coupling.

Botulinumtoxin Improves both Generic and Disease-Specific Quality of Life in Cervical Dystonia

Botulinumtoxin injection (BoNT) into affected muscles is effective to improve motor symptoms of cervical dystonia (CD) by reducing muscle contraction and involuntary dystonic movement and posturing. However, the understanding of the effect on health-related quality of life (HR-QoL) and patient referral under HR-QoL aspects is incomplete. In this open-label clinical prospective observational study, we characterized the outcomes in CD (n = 159) from botulinumtoxin on both generic HR-QoL (EuroQol; EQ-5D-5L) and disease-specific HR-QoL [craniocervical dystonia questionnaire (CDQ-24)]. Additionally, we characterized motor and non-motor signs of dystonia including motor symptom improvement, depressive symptoms, pain, and sleep quality. We assessed patients at the end of a regular 3-month period from last injection (Timepoint1) and 4 weeks after the re-injection of BoNT (Timepoint2). We aimed to define outcomes on both generic and disease-specific HR-QoL and to evaluate predictors of therapeutic outcome in terms of stepwise multiple regression models. Patients with CD showed a robust improvement of both generic and disease-specific HR-QoL. Furthermore, motor and non-motor signs improved. Multiple regression analyses revealed that EQ-5D-5L and “satisfaction with health” (Fragen zur Lebenszufriedenheit-G) at Timepoint1 predicted treatment response on generic HR-QoL outcome (R² = 0.284; P = 0.019). Similarly, CDQ-24 and Beck’s Depression inventory at Timepoint1 predicted the treatment response on disease-specific HR-QoL (R² = 0.253; P = 0.026). Our study underscores both generic and disease-specific HR-QoL improvements in CD, and provides useful predictors on HR-QoL outcomes.

Coexistence of sarcoidosis and metastatic lesions: A diagnostic and therapeutic dilemma

Sarcoidosis, a chronic, inflammatory disease that affects various different organs, is characterized by noncaseating epitheloid granulomas. This systemic inflammatory process is associated with an increased risk of cancer. Several cases of sarcoidosis that mimic metastatic tumor progression in radiological findings have been reported so far. However, there are also cases that have presented a coexistence of sarcoidosis and metastasis, which have caused a diagnostic and therapeutic dilemma. Due to inadequate current therapies, a reliable differentiation between benign and malignant lesions is crucial. This review focuses on the residual risk of the coexistence of metastases within radiological suspicious lesions in patients with a history of solid tumors and sarcoidosis, as well as immunological findings, in order to explain the potential associations. Sarcoidosis has the potential to promote metastasis as it includes tumor-promoting and immune-regulating cell subsets. Notably, myeloid derived suppressor cells may serve a pivotal role in metastatic progression in patients with sarcoidosis. In addition, the present review also evaluates the potential novel diagnostic approaches, which may be able to differentiate between metastatic lesions and sarcoidosis. The risk of coexistent metastasis in sarcoidosis lesions must be considered by clinical practitioners, and a multidisciplinary approach may be required to avoid misdiagnosis and the subsequent unnecessary surgery or insufficient treatments.

Effects of Subthalamic and Nigral Stimulation on Gait Kinematics in Parkinson's Disease

Conventional subthalamic deep brain stimulation for Parkinson's disease (PD) presumably modulates the spatial component of gait. However, temporal dysregulation of gait is one of the factors that is tightly associated with freezing of gait (FOG). Temporal locomotor integration may be modulated differentially at distinct levels of the basal ganglia. Owing to its specific descending brainstem projections, stimulation of the substantia nigra pars reticulata (SNr) area might modulate spatial and temporal parameters of gait differentially compared to standard subthalamic nucleus (STN) stimulation. Here, we aimed to characterize the differential effect of STN or SNr stimulation on kinematic gait parameters. We analyzed biomechanical parameters during unconstrained over ground walking in 12 PD patients with subthalamic deep brain stimulation and FOG. Patients performed walking in three therapeutic conditions: (i) Off stimulation, (ii) STN stimulation (alone), and (iii) SNr stimulation (alone). SNr stimulation was achieved by stimulating the most caudal contact of the electrode. We recorded gait using three sensors (each containing a tri-axial accelerometer, gyroscope, and magnetometer) attached on both left and right ankle, and to the lumbar spine. STN stimulation improved both the spatial features (stride length, stride length variability) and the temporal parameters of gait. SNr stimulation improved temporal parameters of gait (swing time asymmetry). Correlation analysis suggested that patients with more medial localization of the SNr contact associated with a stronger regularization of gait. These results suggest that SNr stimulation might support temporal regularization of gait integration.

Classification of advanced stages of Parkinson's disease: translation into stratified treatments

Advanced stages of Parkinson's disease (advPD) still impose a challenge in terms of classification and related stage-adapted treatment recommendations. Previous concepts that define advPD by certain milestones of motor disability apparently fall short in addressing the increasingly recognized complexity of motor and non-motor symptoms and do not allow to account for the clinical heterogeneity that require more personalized approaches. Therefore, deep phenotyping approaches are required to characterize the broad-scaled, continuous and multidimensional spectrum of disease-related motor and non-motor symptoms and their progression under real-life conditions. This will also facilitate the reasoning for clinical care and therapeutic decisions, as neurologists currently have to refer to clinical trials that provide guidance on a group level; however, this does not always account for the individual needs of patients. Here, we provide an overview on different classifications for advPD that translate into critical phenotypic patterns requiring the differential therapeutic adjustments. New concepts refer to precision medicine approaches also in PD and first studies on genetic stratification for therapeutic outcomes provide a potential for more objective treatment recommendations. We define novel treatment targets that align with this concept and make use of emerging device-based assessments of real-life information on PD symptoms. As these approaches require empowerment of patients and integration into treatment decisions, we present communication strategies and decision support based on new technologies to adjust treatment of advPD according to patient demands and safety.

Association Between Facial Nerve Monitoring With Postoperative Facial Paralysis in Parotidectomy

IMPORTANCE

Electrophysiologic facial nerve monitoring is becoming an established intraoperative aid to assist the surgeon in facial nerve trunk or branch location and dissection. Limited studies have addressed the postoperative outcomes of parotid surgery with and without monitoring.

OBJECTIVE

To examine the influence of intraoperative facial nerve monitoring on postoperative facial nerve function and procedure duration in parotid surgery.

DESIGN, SETTING, AND PARTICIPANTS

An 8-year retrospective review of parotidectomies performed at the Department of Otorhinolaryngology-Head and Neck Surgery, University of Münster. The study analyzed 120 patients undergoing parotidectomy without monitoring from January 1, 1988, to December 31, 1991, and 147 patients undergoing parotidectomy with monitoring from January 1, 2003, to December 31, 2006. The patients were further subdivided in partial parotidectomy (PP) (n = 222) and total parotidectomy (TP) (n = 45) groups. An evaluation of operative time was performed to test the hypothesis of shorter duration of surgery with facial nerve monitoring. Final follow-up was completed on December 31, 2008, and data were analyzed from June 1 to December 31, 2013.

MAIN OUTCOMES AND MEASURES

Comparison of the incidence of facial nerve dysfunction and operative time between the PP and TP subgroups with and without monitoring.

RESULTS

A total of 267 patients (127 men [47.6%] and 140 women [52.4%]; mean [SD] age, 51.3 [17.6] years; range, 3-90 years) were included in the analysis. A significant reduction in postoperative facial nerve dysfunction with the use of nerve monitoring could be seen in the PP group (46 of 99 without monitoring [46.5%] vs 18 of 123 with monitoring [14.6%]; P = .001). A similar finding was evident in the TP group when comparing moderate and severe nerve dysfunction (9 of 21 without monitoring [42.9%] vs 2 of 24 with monitoring [8.3%]; P = .01). The mean (SD) operative time in the PP subgroup without nerve monitoring was 115.3 (37.8) minutes; with nerve monitoring, 110.1 (33.6) minutes. The mean (SD) operative time in the TP subgroup without nerve monitoring was 134.5 (50.4) minutes; with nerve monitoring, 158.3 (56.3) minutes. There was no statistical difference between these groups.

CONCLUSIONS AND RELEVANCE

Facial nerve monitoring in primary parotid surgery for benign and malignant disease does not necessarily reduce the operative time, but the rate of transient postoperative facial nerve dysfunction or the grade of palsy is reduced.

Impact on psychosocial outcomes of a nationally available weight management program tailored for individuals with type 2 diabetes: Results of a randomized controlled trial

AIMS

Type 2 diabetes mellitus (T2DM) can substantially decrease quality of life (QOL). This study examined the effects on QOL-relevant psychosocial measures of a widely available commercial weight loss program enhanced for individuals with T2DM.

METHODS

A year-long multi-site randomized clinical trial compared the Weight Watchers (WW) approach, supplemented with phone and email counseling with a certified diabetes educator (CDE), to brief standard diabetes nutrition counseling and education (Standard Care; SC). Participants were 400 women and 163 men (N=279 WW; 284 SC) with T2DM [mean (±SD) HbA_1c 8.32±1%; BMI=37.1±5.7kg/m²; age=55.1 ± 9.1years]. Psychosocial outcomes were assessed at baseline, month 6, and month 12 using a diabetes specific psychosocial measure (Diabetes Distress Scale [DDS]), Impact of Weight on Quality of Life-Lite scale (IWQOL), a generic QOL measure (SF-36), and a depression screen (PHQ-9).

RESULTS

WW participants showed significantly greater improvements than did SC participants on all DDS subscales and total score and on IWQOL total score and physical function, sex life and work domains (all ps<.05). There was no significant treatment effect on SF-36 scores or PHQ-9.

CONCLUSIONS

WW enhanced for individuals with T2DM was superior to SC in improving psychosocial outcomes most specific to T2DM and obesity. Available commercial WL programs, combined with scalable complementary program-specific diabetes counseling, may have benefits that extend to diabetes-related distress and weight-relevant QOL.

Predictors of hearing recovery in patients with severe sudden sensorineural hearing loss

Background

Sudden sensorineural hearing loss (SSHL) is a disease, which severely affects the patient’s social and relational life. The underlying pathomechanisms have not been finally clarified yet and outcome is not predictable.

Methods

We conducted a retrospective study in order to identify parameters that influence hearing recovery. The data base contains results of basic otoneurological tests and clinical parameters of 198 patients with idiopathic SSHL of at least 60 dB in at least four frequencies, diagnosed and treated at the University Hospital of Münster, Germany, between 1999 and 2015. Hearing recovery was measured by pure tone audiometry.

Results

Multivariate linear and logistic regression analyses indicate that the chance as well as the magnitude of hearing recovery is higher for patients with normal caloric testing than for patients with pathological caloric testing. However, for the subgroup of patients who attained a hearing recovery, the caloric testing result was not found to influence the magnitude. Instead, the magnitude was noticeably lower for patients within this subgroup who had a previous hearing loss. Furthermore, we found indications that the magnitude is higher for men than for women and that receiving a high-dose steroid therapy is associated with a higher chance and magnitude of a hearing recovery.

Conclusions

We conclude that SSHL associated with disorders of the vestibular system or previous hearing loss represent special sub-entities of SSHL that may be caused by unique pathophysiological mechanisms and are associated with worse outcome. Furthermore, our data support the importance of elevated dosage of steroids in SSHL therapy.

[Innovative Ultrasound: Contrast-Enhanced Ultrasound of the Kidneys]

Ultrasound examination of the kidneys with grey-scale imaging and colour Doppler ultrasound is the most common renal imaging modality. A few years ago, contrast-enhanced ultrasound (CEUS) emerged as a non-invasive perfusion imaging modality to evaluate the renal vessels and microvascularisation. These contrast media contain intravenous microbubbles (sulfur hexafluoride), which have no deleterious effect on renal function. Being free of iodine, they also pose no risk for the thyroid gland. CEUS of the kidneys is mainly used for the evaluation of renal cysts and the analysis of renal lesions suspicious for malignancy. Also this method is used to visualise inflammation as well as renal perfusion after trauma or infarction.

Health-related quality of life outcomes from botulinum toxin treatment in hemifacial spasm

BACKGROUND

Although botulinum neurotoxin (BoNT) injections may alleviate involuntary muscle contractions in hemifacial spasm substantially, it is less clear whether the motor effect would translate into improvements of health-related quality of life (HR-QoL).

METHODS

In this open-label clinical observational study, we characterized outcomes on HR-QoL in terms of the EuroQol (EQ-5D-5L) from BoNT in a prospective cohort of patients with hemifacial spasm (n = 73). Additionally, we characterized appendicular motor and nonmotor signs on motor symptom improvement, depressive symptoms, pain and sleep quality. Patients were assessed at the end of a regular 3-month period from last injection (timepoint1) and 4 weeks after the reinjection of BoNT (timepoint2).

RESULTS

Patients showed improved HR-QoL on the EQ-VAS (visual analogue scale) at timepoint2 compared with timepoint1. Moreover, we identified, that impairments in HR-QoL at timepoint1 correlated with life satisfaction and depressive symptoms, respectively. However, these associated variables did not predict the therapeutic effect. Instead, EQ-VAS at timepoint1 accounted for 34.5% of the variance of EQ-VAS improvement expressed as the difference between timepoint2 and timepoint1.

CONCLUSION

Our study supports HR-QoL improvements in hemifacial spasm and the value of generic HR-QoL measures to estimate therapeutic outcome. However, the findings should be considered descriptive, and future high quality trials are needed for confirmatory purposes in order to refine treatment referral in hemifacial spasm with respect to QoL.

Characteristics of mesenteric lymphadenitis in comparison with those of acute appendicitis in children

Mesenteric lymphadenitis (ML) is considered as one of the most common alternative diagnosis in a child with suspected acute appendicitis (AA). In this retrospective study, patients diagnosed with ML (n = 99) were compared in terms of demographic, clinical, and laboratory findings to patients diagnosed with AA (n = 102). This comparison was applied for both lymph nodes smaller and larger than 10 mm. When compared to patients with AA, patients with ML had significantly longer duration of symptoms prior to emergency department (ED) presentation (2.4 ± 2.6 vs 1.4 ± 1.4 days, P = 0.002) and multiple ED presentations (1.3 ± 0.7 vs 1.05 ± 0.3, P < 0.001) and had longer duration of stay in the ED (9.2 ± 5.9 vs 5.2 ± 4 h, P < 0.001), respectively. They also had significantly lower WBC (10.16 ± 4.7 × 10³/dl vs 15.8 ± 4.4 × 10³/dl, P < 0.001) with lymphocyte predominance (24.6 ± 14 vs 13 ± 8.7%, P < 0.001) and lower CRP levels (0.48 vs 1.6 mg/dl). Migration of pain (28 vs 7%), vomiting (62 vs 34%), and classic abdominal findings of AA (72 vs 20%) were all significantly more common for children with AA. When comparing lymph node size, no significant difference was found between those presenting with small and large nodes.

CONCLUSION

This study highlights multiple clinical and laboratory findings that differentiate ML and AA. Moreover, the absence of any difference with regard to the lymph nodes size might suggest that lymph nodes enlargement is a non-specific finding. What is Known : • Mesenteric lymphadenitis is a very common diagnosis in children with suspected acute appendicitis. • Despite its prevalence, only few studies addressed the clinical characteristics of this clinical entity and their comparison with acute appendicitis. What is New: • Mesenteric lymphadenitis and acute appendicitis could be differentiated by multiple clinical and laboratory parameters. • No significant difference was found between those presenting with small and large lymph nodes.

Robust spin-orbit torque and spin-galvanic effect at the Fe/GaAs (001) interface at room temperature

Interfacial spin-orbit torques (SOTs) enable the manipulation of the magnetization through in-plane charge currents, which has drawn increasing attention for spintronic applications. The search for material systems providing efficient SOTs, has been focused on polycrystalline ferromagnetic metal/non-magnetic metal bilayers. In these systems, currents flowing in the non-magnetic layer generate—due to strong spin–orbit interaction—spin currents via the spin Hall effect and induce a torque at the interface to the ferromagnet. Here we report the observation of robust SOT occuring at a single crystalline Fe/GaAs (001) interface at room temperature. We find that the magnitude of the interfacial SOT, caused by the reduced symmetry at the interface, is comparably strong as in ferromagnetic metal/non-magnetic metal systems. The large spin-orbit fields at the interface also enable spin-to-charge current conversion at the interface, known as spin-galvanic effect. The results suggest that single crystalline Fe/GaAs interfaces may enable efficient electrical magnetization manipulation.

Interfacial spin-orbit torque allows electrical manipulation of magnetization, but this has been shown mostly in polycrystalline metal bilayers. Here the authors show robust spin-orbit torque in single crystalline Fe/GaAs interface at room temperature, observing conversion between spin and charge current.

Randomized controlled trial of a nationally available weight control program tailored for adults with type 2 diabetes

OBJECTIVE

Modest weight loss from clinical interventions improves glycemic control in type 2 diabetes (T2DM). Data are sparse on the effects of weight loss via commercial weight loss programs. This study examined the effects on glycemic control and weight loss of the standard Weight Watchers program, combined with telephone and email consultations with a certified diabetes educator (WW), compared with standard diabetes nutrition counseling and education (standard care, SC).

METHODS

In a 12-month randomized controlled trial at 16 U.S. research centers, 563 adults with T2DM (HbA_1c 7-11%; BMI 27-50 kg/m² ) were assigned to either the commercially available WW program (regular community meetings, online tools), plus telephone and email counseling from a certified diabetes educator, or to SC (initial in-person diabetes nutrition counseling/education, with follow-up informational materials).

RESULTS

Follow-up rate was 86%. Twelve-month HbA_1c changes for WW and SC were -0.32 and +0.16, respectively; 24% of WW versus 14% of SC achieved HbA_1c <7.0% (P = 0.004). Weight losses were -4.0% for WW and -1.9% for SC (Ps < 0.001). 26% of WW versus 12% of SC reduced diabetes medications (P < 0.001). WW participants had greater reductions in waist circumference (P < 0.001) and C-reactive protein (P = 0.02) but did not differ on other cardiovascular risk factors.

CONCLUSIONS

Widely available commercial weight loss programs with community and online components, combined with scalable complementary diabetes education, may represent accessible and effective components of management plans for adults with overweight/obesity and T2DM.

New Insights from Zinc and Copper Isotopic Compositions into the Sources of Atmospheric Particulate Matter from Two Major European Cities

This study reports spatial and temporal variability of Zn and Cu isotopes in atmospheric particulate matter (PM) collected in two major European cities with contrasting atmospheric pollution, Barcelona and London. We demonstrate that nontraditional stable isotopes identify source contributions of Zn and Cu and can play a major role in future air quality studies. In Barcelona, samples of fine PM were collected at street level at sites with variable traffic density. The isotopic signatures ranged between -0.13 ± 0.09 and -0.51 ± 0.05‰ for δ(66)ZnIRMM and between +0.04 ± 0.20 and +0.33 ± 0.15‰ for δ(65)CuAE633. Copper isotope signatures similar to those of Cu sulfides and Cu/Sb ratios within the range typically found in brake wear suggest that nonexhaust emissions from vehicles are dominant. Negative Zn isotopic signatures characteristic for gaseous emissions from smelting and combustion and large enrichments of Zn and Cd suggest contribution from metallurgical industries. In London, samples of coarse PM collected on the top of a building over 18 months display isotope signatures ranging between +0.03 ± 0.04 and +0.49 ± 0.02‰ for δ(66)ZnIRMM and between +0.37 ± 0.17 and +0.97 ± 0.21‰ for δ(65)CuAE633. Heavy Cu isotope signatures (up to +0.97 ± 0.21‰) and higher enrichments and Cu/Sb ratios during winter time indicate important contribution from fossil fuel combustion. The positive δ(66)ZnIRMM signatures are in good agreement with signatures characteristic for ore concentrates used for the production of tires and galvanized materials, suggesting nonexhaust emissions from vehicles as the main source of Zn pollution.

The Search Conference as a Method in Planning Community Health Promotion Actions

Aims: The aim of this article is to describe and discuss how the search conference can be used as a method for planning health promotion actions in local communities.

Design and methods: The article draws on experiences with using the method for an innovative project in health promotion in three Norwegian municipalities. The method is described both in general and how it was specifically adopted for the project.

Results and conclusions: The search conference as a method was used to develop evidence-based health promotion action plans. With its use of both bottom-up and top-down approaches, this method is a relevant strategy for involving a community in the planning stages of health promotion actions in line with political expectations of participation, ownership, and evidence-based initiatives.

Tailoring Supramolecular Nanofibers for Air Filtration Applications

The demand of new materials and processes for nanofiber fabrication to enhance the performance of air filters is steadily increasing. Typical approaches to obtain nanofibers are based on top-down processes such as melt blowing, centrifugal spinning, and electrospinning of polymer materials. However, fabrication of polymer nanofibers is limited with respect to either a sufficiently high throughput or the smallest achievable fiber diameter. This study reports comprehensively on a fast and simple bottom-up process to prepare supramolecular nanofibers in situ inside viscose/polyester microfiber nonwovens. Here, selected small molecules of the materials class of 1,3,5-benzenetrisamides are employed. The microfiber-nanofiber composites exhibit a homogeneous nanofiber distribution and morphology throughout the entire nonwoven scaffold. Small changes in molecular structure and processing solvent have a strong influence on the final nanofiber diameter and diameter distribution and, consequently, on the filtration performance. Choosing proper processing conditions, microfiber-nanofiber composites with surprisingly high filtration efficiencies of particulate matter are obtained. In addition, the microfiber-nanofiber composite integrity at elevated temperatures was determined and revealed that the morphology of supramolecular nanofibers is maintained compared to that of the utilized polymer nonwoven.

An Unsupervised Online Spike-Sorting Framework

Extracellular neuronal microelectrode recordings can include action potentials from multiple neurons. To separate spikes from different neurons, they can be sorted according to their shape, a procedure referred to as spike-sorting. Several algorithms have been reported to solve this task. However, when clustering outcomes are unsatisfactory, most of them are difficult to adjust to achieve the desired results. We present an online spike-sorting framework that uses feature normalization and weighting to maximize the distinctiveness between different spike shapes. Furthermore, multiple criteria are applied to either facilitate or prevent cluster fusion, thereby enabling experimenters to fine-tune the sorting process. We compare our method to established unsupervised offline (Wave_Clus (WC)) and online (OSort (OS)) algorithms by examining their performance in sorting various test datasets using two different scoring systems (AMI and the Adamos metric). Furthermore, we evaluate sorting capabilities on intra-operative recordings using established quality metrics. Compared to WC and OS, our algorithm achieved comparable or higher scores on average and produced more convincing sorting results for intra-operative datasets. Thus, the presented framework is suitable for both online and offline analysis and could substantially improve the quality of microelectrode-based data evaluation for research and clinical application.

Thyroid cartilage invasion in laryngeal and hypopharyngeal squamous cell carcinoma treated with total laryngectomy

The objective of this study is to analyze the accuracy of computed tomography in detecting malignant thyroid cartilage invasion. In a retrospective chart review, 120 patients with carcinoma of the larynx and hypopharynx underwent computed tomography before total laryngectomy. These data were compared with the histological specimens. Multidetector computed tomography (MDCT) scan had a positive predictive value (PPV) of 76 % and a negative predictive value (NPV) of 69 %. The specificity of MDCT was 89 % and sensitivity was 46 %. Comparison between radiologic suspected cartilage invasion and histologic results showed a significant correlation (p < 0.02). We found no significant impact of cartilage invasion concerning survival rates (5-year overall survival p = 0.683; 5-year disease-free survival p = 0.711). Preoperative CT scan is an important instrument in detecting neoplastic cartilage invasion.

Sexual selection on male vocal fundamental frequency in humans and other anthropoids

In many primates, including humans, the vocalizations of males and females differ dramatically, with male vocalizations and vocal anatomy often seeming to exaggerate apparent body size. These traits may be favoured by sexual selection because low-frequency male vocalizations intimidate rivals and/or attract females, but this hypothesis has not been systematically tested across primates, nor is it clear why competitors and potential mates should attend to vocalization frequencies. Here we show across anthropoids that sexual dimorphism in fundamental frequency (F0) increased during evolutionary transitions towards polygyny, and decreased during transitions towards monogamy. Surprisingly, humans exhibit greater F0 sexual dimorphism than any other ape. We also show that low-F0 vocalizations predict perceptions of men's dominance and attractiveness, and predict hormone profiles (low cortisol and high testosterone) related to immune function. These results suggest that low male F0 signals condition to competitors and mates, and evolved in male anthropoids in response to the intensity of mating competition.

Probing Quantum Capacitance in a 3D Topological Insulator

We measure the quantum capacitance and probe thus directly the electronic density of states of the high mobility, Dirac type two-dimensional electron system, which forms on the surface of strained HgTe. Here we show that observed magnetocapacitance oscillations probe-in contrast to magnetotransport-primarily the top surface. Capacitance measurements constitute thus a powerful tool to probe only one topological surface and to reconstruct its Landau level spectrum for different positions of the Fermi energy.

Detecting a Cortical Fingerprint of Parkinson's Disease for Closed-Loop Neuromodulation

Recent evidence suggests that deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) mediates its clinical effects by modulating cortical oscillatory activity, presumably via a direct cortico-subthalamic connection. This observation might pave the way for novel closed-loop approaches comprising a cortical sensor. Enhanced beta oscillations (13-35 Hz) have been linked to the pathophysiology of PD and may serve as such a candidate marker to localize a cortical area reliably modulated by DBS. However, beta-oscillations are widely distributed over the cortical surface, necessitating an additional signal source for spotting the cortical area linked to the pathologically synchronized cortico-subcortical motor network. In this context, both cortico-subthalamic coherence and cortico-muscular coherence (CMC) have been studied in PD patients. Whereas, the former requires invasive recordings, the latter allows for non-invasive detection, but displays a rather distributed cortical synchronization pattern in motor tasks. This distributed cortical representation may conflict with the goal of detecting a cortical localization with robust biomarker properties which is detectable on a single subject basis. We propose that this limitation could be overcome when recording CMC at rest. We hypothesized that-unlike healthy subjects-PD would show CMC at rest owing to the enhanced beta oscillations observed in PD. By performing source space analysis of beta CMC recorded during resting-state magnetoencephalography, we provide preliminary evidence in one patient for a cortical hot spot that is modulated most strongly by subthalamic DBS. Such a spot would provide a prominent target region either for direct neuromodulation or for placing a potential sensor in closed-loop DBS approaches, a proposal that requires investigation in a larger cohort of PD patients.

A Survey of Oral Cancer Screening Insurance Coverage in New York City

Clinical studies show that fewer than 25% of people who visit a dentist regularly are screened for oral cancer, and that the majority of oral cancers present at an advanced stage, when cure rates are already abysmal. This study explores the current status of oral cancer screening coverage among a variety of insurance providers in New York City. The study focuses on determining the coverage and frequency of the cluster of salient CDT (dental) codes surrounding oral cancer screenings.

Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level

BACKGROUND

Health promotion, with a focus on multidimensional upstream factors and an ecological, life-course approach, is establishing itself as the guiding philosophy for addressing public health. Action at the political and programmatic level on the Social Determinants of Health has proven effective for promoting and building public health at all levels but has been particularly evident at the national and international levels - due in large part to available documents and guidelines. Although research and experience establish that health promotion is most effective when settings-based, the development of health promoting policies and programs at the local level is still difficult. This study intended to investigate available knowledge on the development and implementation of health promoting policies and programs at the local level and identify factors most important for facilitating capacity building and outcome achievement.

METHODS

We used a scoping review in order to review the current literature on local policy development and program implementation. Keywords were chosen based on results of a previous literature review. A total of 53 articles were divided into two categories: policy and implementation. Critical analysis was conducted for each article and a summary assembled. Data was charted with specific focus on the aims of the study, data acquisition, key theories/concepts/frameworks used, outcome measures, results, and conclusions.

RESULTS

The articles included in this study primarily focused on discussing factors that facilitate the development of health promoting policy and the implementation of health promotion programs. Most significant facilitators included: collaborative decision-making, agreement of objectives and goals, local planning and action, effective leadership, building and maintaining trust, availability of resources, a dynamic approach, a realistic time-frame, and trained and knowledgeable staff. Within each of these important facilitating factors, various elements supporting implementation were discussed and highlighted in this study.

CONCLUSION

Our results indicate that clear and consistent facilitators exist for supporting health promoting policy development and program implementation at the local level. These results offer a starting point for local action on the Social Determinants of Health and have the potential to contribute to the development of a framework for improving action at the local level.

Clinicopathological and immunohistochemical characteristics of surgically treated primary carcinoma of the nasal vestibule - an evaluation of 30 cases

OBJECTIVES/HYPOTHESIS

Squamous cell carcinoma of the nasal vestibule (SCCNV) is a rare tumour entity. Treatment modality, particularly indication of neck dissection, is still a controversial subject of debate. We sought to evaluate the occurrence of lymph node metastases, the prognosis and the immunohistochemical characteristics of SCCNV.

STUDY DESIGN

Retrospective cohort study.

METHODS

This study included 30 consecutive patients with SCCNV treated with primary tumour resection and neck dissection in cases of suspicious lymph nodes between 2003 and 2013. According to therapeutical standard adjuvant radiotherapy or chemotherapy were applied in some cases. Clinicopathological data and immunohistochemical expression of CK5/6, EGFR, Ki-67, MMP-2, MMP-9, p53 and VEGFR were analysed.

RESULTS

The median follow-up period was 47.1 months. Five-year disease-free (5-year DFS) and 5-year overall survival (5-year OS) were 91.7% and 92.3%. Five-year OS in low-grade tumours (G1, G2) was 100.0%, in high-grade tumours (G3) 75.0% (P = 0.028), respectively. We did not detect any lymph node metastases in the neck dissections. Overexpression of p53 showed a trend for better 5-year OS (p53-positive 100% versus p53-negative 77.8%, n.s.). We found a positive correlation between p53 and EGFR (P = 0.0001). There was no significant relationship between the expression rates of the markers and tumour stage and grading.

CONCLUSIONS

We propose no prophylactic neck dissection in small-sized SCCNV. Subtile endoscopic follow-up and periodic ultrasound examination of the cervical lymph nodes after surgical treatment are recommended. Further evaluation of the p53- and EGFR-pathways might pave the way to identify possible molecular targets in an attempt to tailor tumour management.

Fine resolution mapping of population age-structures for health and development applications

The age-group composition of populations varies considerably across the world, and obtaining accurate, spatially detailed estimates of numbers of children under 5 years is important in designing vaccination strategies, educational planning or maternal healthcare delivery. Traditionally, such estimates are derived from population censuses, but these can often be unreliable, outdated and of coarse resolution for resource-poor settings. Focusing on Nigeria, we use nationally representative household surveys and their cluster locations to predict the proportion of the under-five population in 1 × 1 km using a Bayesian hierarchical spatio-temporal model. Results showed that land cover, travel time to major settlements, night-time lights and vegetation index were good predictors and that accounting for fine-scale variation, rather than assuming a uniform proportion of under 5 year olds can result in significant differences in health metrics. The largest gaps in estimated bednet and vaccination coverage were in Kano, Katsina and Jigawa. Geolocated household surveys are a valuable resource for providing detailed, contemporary and regularly updated population age-structure data in the absence of recent census data. By combining these with covariate layers, age-structure maps of unprecedented detail can be produced to guide the targeting of interventions in resource-poor settings.

Zinc Isotope Variability in Three Coal-Fired Power Plants: A Predictive Model for Determining Isotopic Fractionation during Combustion

The zinc (Zn) isotope compositions of feed materials and combustion byproducts were investigated in three different coal-fired power plants, and the results were used to develop a generalized model that can account for Zn isotopic fractionation during coal combustion. The isotope signatures in the coal (δ(66)ZnIRMM) ranged between +0.73 and +1.18‰, values that fall well within those previously determined for peat (+0.6 ±2.0‰). We therefore propose that the speciation of Zn in peat determines the isotope fingerprint in coal. All of the bottom ashes collected in these power plants were isotopically depleted in the heavy isotopes relative to the coals, with δ(66)ZnIRMM values ranging between +0.26‰ and +0.64‰. This suggests that the heavy isotopes, possibly associated with the organic matter of the coal, may be preferentially released into the vapor phase. The fly ash in all of these power plants was, in contrast, enriched in the heavy isotopes relative to coal. The signatures in the fly ash can be accounted for using a simple unidirectional fractionation model with isotope fractionation factors (αsolid-vapor) ranging between 1.0003 and 1.0007, and we suggest that condensation is the controlling process. The model proposed allows, once the isotope composition of the feed coal is known, the constraining of the Zn signatures in the byproducts. This will now enable the integration of Zn isotopes as a quantitative tool for the source apportionment of this metal from coal combustion in the atmosphere.

Label-free monitoring of whole cell vitality

The Intelligent Mobile Lab (IMOLA) delivers metabolic and morphological parameters of living cells in a label-free and real time way. It represents a key technology for the development of new cell-based assays. Electrochemical microsensors are used to measure the extracellular acidification (pH), cellular respiration (pO2), changes in cell number and morphology (electric impedance) in a controlled environment. These parameters are closely linked to the intracellular signaling network of the living cells. They are thus likely to respond sensitively to changes in cellular vitality. A wide spectrum of cell types can be tested with the system, including adherent and suspended cells, continuous cell lines, primary cells or tissue samples. The platform is described in detail and applications in the field's oncology, toxicology and environmental monitoring are shown.

The impact of a three-factor prothrombin complex concentrate on the anticoagulatory effects of the factor Xa inhibitor edoxaban

BACKGROUND

Edoxaban, a direct factor Xa inhibitor, is a once-daily, non-vitamin K antagonist oral anticoagulant. There is no established method to reverse the activity of non-vitamin K oral anticoagulants in cases of hemorrhage or urgent surgery. This study evaluated the ability of a 3-factor prothrombin complex concentrate (3F-PCC) to reverse the anticoagulatory effects of edoxaban.

METHODS

In this phase 1 study, 24 healthy subjects were randomly assigned to receive a single dose of 60 or 180mg edoxaban, followed by placebo, 25IU/kg 3F-PCC, or 50IU/kg 3F-PCC. Edoxaban pharmacokinetics and pharmacodynamics, including the primary endpoint of prothrombin time (PT) and endogenous thrombin potential (ETP), were assessed. D-dimer and prothrombin fragment 1 and 2 (F1+2) were also measured.

RESULTS

Overall, there were no apparent consistent effects of 3F-PCC on edoxaban pharmacokinetics. Administration of 3F-PCC 25 or 50IU/kg with edoxaban 60 or 180mg did not substantially accelerate the return of PT to baseline levels. However, infusion of 3F-PCC 25 and 50IU/kg did substantially accelerate return to baseline of ETP compared with placebo. D-dimer and F1+2 data did not indicate any lasting procoagulant effects of 3F-PCC infusion, although a transient increase in F1+2 was noted during and after 3F-PCC infusion. Edoxaban and 3F-PCC co-administration was well tolerated in normal healthy subjects.

CONCLUSIONS

There was no apparent reversal of PT prolongation with 3F-PCC following edoxaban infusion, but ETP was completely reversed. Co-administration of 3F-PCC was well tolerated, but a dose-dependent increase in F1+2 may reflect a procoagulant risk.

Emergence of spin-orbit fields in magnetotransport of quasi-two-dimensional iron on gallium arsenide

The desire for higher information capacities drives the components of electronic devices to ever smaller dimensions so that device properties are determined increasingly more by interfaces than by the bulk structure of the constituent materials. Spintronic devices, especially, benefit from the presence of interfaces—the reduced structural symmetry creates emergent spin–orbit fields that offer novel possibilities to control device functionalities. But where does the bulk end, and the interface begin? Here we trace the interface-to-bulk transition, and follow the emergence of the interfacial spin–orbit fields, in the conducting states of a few monolayers of iron on top of gallium arsenide. We observe the transition from the interface- to bulk-induced lateral crystalline magnetoanisotropy, each having a characteristic symmetry pattern, as the epitaxially grown iron channel increases from four to eight monolayers. Setting the upper limit on the width of the interface-imprinted conducting channel is an important step towards an active control of interfacial spin–orbit fields.

Broken symmetry at material interfaces allows for novel spintronic functionality via emergent spin–orbit effects. Here, Hupfauer et al. follow the interface-to-bulk transition of ultra-thin epitaxial iron films on gallium arsenide via anisotropic magnetoresistance measurements and first-principle calculations.