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Within the vigilance regulation model the hyperactivity and sensation seeking observed in overtired children, ADHD and mania are interpreted as an autoregulatory attempt to stabilize vigilance (central nervous arousal) by increasing external stimulation. Correspondingly the withdrawal and sensation avoidance in major depression is interpreted as a reaction to a state of tonically high vigilance (1, 2). Using an EEG-based algorithm to classify automatically short EEG-segments into different vigilance stages as observed during the transition from active wakefulness to drowsiness and sleep onset (VIGALL), both patients with ADHD and mania show an unstable vigilance regulation with rapid drops to lower vigilance stages under quiet rest. The contrary was found in unmedicated patients with major depression (2). Studies will be presented supporting the validity of VIGALL (simulataneous EEG-fMRI and EEG/FDG-PET studies, as well as the neurophysiological, clinical and predictive validity of the vigilance regulation model of affective disorders. Among the far reaching consequences of the vigilance model is the question whether psychostimulants have similar beneficial effects in mania as observed in ADHD (3), an aspect which is presently studied in an international, randomized controlled trial (4).
Minor depression is diagnosed when a patient suffers from two to four depressive symptoms for at least two weeks. Though minor depression is a widespread phenomenon, its pathophysiology has hardly been studied. To get a first insight into the pathophysiological mechanisms underlying this disorder we assessed serum levels of biomarkers for plasticity, glial and neuronal function: brain-derived neurotrophic factor (BDNF), S100B and neuron specific enolase (NSE). Twenty-seven subjects with minor depressive episode and 82 healthy subjects over 60 years of age were selected from the database of the Leipzig population-based study of civilization diseases (LIFE). Serum levels of BDNF, S100B and NSE were compared between groups, and correlated with age, body-mass index, and degree of white matter hyperintensities (score on Fazekas scale). S100B was significantly increased in males with minor depression in comparison to healthy males, whereas other biomarkers did not differ between groups (P = 0.10–0.66). NSE correlated with Fazekas score in patients with minor depression (rs = 0.436, P = 0.048) and in the whole sample (rs = 0.252, P = 0.019). S100B correlated with body mass index (rs = 0.246, P = 0.031) and with age in healthy subjects (rs = 0.345, P = 0.002). Increased S100B in males with minor depression, without alterations in BDNF and NSE, supports the glial hypothesis of depression. Correlation between white matter hyperintensities and NSE underscores the vascular hypothesis of late life depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In the last years, perovskite solar cells have attracted great interest in photovoltaic (PV) research due to their possibility to become a highly efficient and low-cost alternative to silicon solar cells. Cells based on the widely used Pb-containing perovskites have reached power conversion efficiencies (PCE) of more than 20 %. One of the major hurdles for the rapid commercialization of perovskite photovoltaics is the lack of deposition tools and processes for large areas. Chemical vapor deposition (CVD) is an appealing technique because it is scalable and furthermore features superior process control and reproducibility in depositing high-purity films. In this work, we present a novel showerhead-based CVD tool to fabricate perovskite films by simultaneous delivery of precursors from the gas phase. We highlight the control of the perovskite film composition and properties by adjusting the individual precursor deposition rates. Providing the optimal supply of precursors results in stoichiometric perovskite films without any detectable residues.
The antiquity of iron meteorites and the inferred early intense heating by the decay of 26Al suggest that many planetesimals were molten beneath a thin insulating cap at the same time as chondrules were being made. As those planetesimals were colliding and merging, it seems inevitable that impact plumes of droplets from their liquid interiors would have been launched into space and cooled to form chondrules. We call the process splashing; it is quite distinct from making droplets by jetting during hypervelocity impacts. Evidence both for the existence of molten planetesimals, and for the cooling of chondrules within a plume setting, is strong and growing. Detailed petrographic and isotopic features of chondrules, particularly in carbonaceous chondrites (that probably formed beyond the orbit of Jupiter), suggest that the chondrule plume would have been ‘dirty’ and the otherwise uniform droplets would have been contaminated with earlier-formed dust and larger grains from a variety of sources. The contamination possibly accounts for relict grains, for the spread of oxygen isotopes along the primitive chondrule mineral (PCM) line in carbonaceous chondrites, and for the newly recognized nucleosynthetic isotopic complementarity between chondrules and matrix in Allende.
We aimed to explore multiple perspectives regarding barriers to and facilitators of advance care planning (ACP) among African Americans to identify similarities or differences that might have clinical implications.
Qualitative study with health disparities experts (n = 5), community members (n = 9), and seriously ill African American patients and caregivers (n = 11). Using template analysis, interviews were coded to identify intrapersonal, interpersonal, and systems-level themes in accordance with a social ecological framework.
Participants identified seven primary factors that influence ACP for African Americans: religion and spirituality; trust and mistrust; family relationships and experiences; patient-clinician relationships; prognostic communication, care preferences, and preparation and control. These influences echo those described in the existing literature; however, our data highlight consistent differences by group in the degree to which these factors positively or negatively affect ACP. Expert participants reinforced common themes from the literature, for example, that African Americans were not interested in prognostic information because of mistrust and religion. Seriously ill patients were more likely to express trust in their clinicians and to desire prognostic communication; they and community members expressed a desire to prepare for and control the end of life. Religious belief did not appear to negate these desires.
Significance of results
The literature on ACP in African Americans may not accurately reflect the experience of seriously ill African Americans. What are commonly understood as barriers to ACP may in fact not be. We propose reframing stereotypical barriers to ACP, such as religion and spirituality, or family, as cultural assets that should be engaged to enhance ACP. Although further research can inform best practices for engaging African American patients in ACP, findings suggest that respectful, rapport-building communication may facilitate ACP. Clinicians are encouraged to engage in early ACP using respectful and rapport building communication practices, including open-ended questions.
We present deep low radio frequency (230-470 MHz) observations from the Karl G. Jansky Very Large Array of the Perseus cluster, probing the non-thermal emission from the old particle population of the AGN outflows. Our observations of this nearby relaxed cool core cluster have revealed a multitude of new structures associated with the mini-halo, extending to hundreds of kpc in size. Its irregular morphology seems to have been influenced both by the AGN activity and by the sloshing motion of the cluster’ gas. In addition, it has a filamentary structure similar to that seen in radio relics found in merging clusters. These results illustrate the high-quality images that can be obtained with the new JVLA at low radio-frequencies.
The Perseus cluster is the X-ray brightest cluster in the sky and with deep Chandra observations we are able to map its central structure on very short spatial scales. In addition, the high quality of X-ray data allows detailed spatially-resolved spectroscopy. In this paper I review what these deep observations have told us about AGN feedback in clusters, sloshing and instabilities, and the metallicity distribution.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Pb-based organometal halide perovskite solar cells have passed the threshold of 20 % power conversion efficiency (PCE). However, the main issues hampering commercialization are toxic Pb contained in these cells and their instability in ambient air. Therefore, great attention is devoted to replace Pb by Sn or Bi, which are less harmful and - in the case of Bi - also expected to yield enhanced stability. In literature, the most efficient hybrid organic-inorganic methylammonium bismuth iodide (MBI) perovskite solar cells reach PCE up to 0.2 %. In this work, we present spin-coated MBI perovskite solar cells and highlight the impact of the concentration of the perovskite solution on the layer morphology and photovoltaic (PV) characteristics. The solar cells exhibit open-circuit voltages of 0.73 V, which is the highest value published for this type of solar cell. The PCE increases from 0.004 % directly after processing to 0.17 % after 48 h of storage in air. 300 h after exposure to air, the cells still yield 56 % of their peak PCE and 84 % of their maximum open-circuit voltage.
Human mesenchymal stem cells were reseeded in decellularized human bone subject to a controlled mechanical loading to create a bone-on-chip that was cultured for over 26 months. The cell morphology and their secretome were characterized using immunohistochemistry and in situ immunofluorescence under confocal microscopy. The presence of stem cell derived osteocytes was confirmed at 547 days. Different cell populations were identified. Some cells were connected by long processes and formed a network. Comparison of the MSCs in vitro reorganization and calcium response to in situ mechanical stimulation were compared to MLOY4 cells reseeded on human bone. The bone-on-chip produced an ECM of which the strength was nearly a quarter of native bone after 109 days and that contained calcium minerals at 39 days and type I collagen at 256 days. The cytoplasmic calcium concentration variations seemed to adapt to the expected in vivo mechanical load at the successive stages of cell differentiation in agreement with studies using fluid shear flow stimulation. Some degree of bone-like formation over a long period of time with the formation of a newly formed matrix was observed.
Our current food consumption patterns, and in particular our meat and dairy intakes, cause high environmental pressure. The present modelling study investigates the impact of diets with less or no meat and dairy foods on nutrient intakes and assesses nutritional adequacy by comparing these diets with dietary reference intakes.
Environmental impact and nutrient intakes were assessed for the observed consumption pattern (reference) and two replacement scenarios. For the replacement scenarios, 30 % or 100 % of meat and dairy consumption (in grams) was replaced with plant-based alternatives and nutrient intakes, greenhouse gas emissions and land use were calculated.
Dutch adults (n 2102) aged 19–69 years.
Replacing 30 % of meat and dairy with plant-based alternatives did not substantially alter percentages below the Estimated Average Requirement (EAR) for all studied nutrients. In the 100 % replacement scenario, SFA intake decreased on average by ~35 % and Na intake by ~8 %. Median Ca intakes were below the Adequate Intake. Estimated habitual fibre, Fe and vitamin D intakes were higher; however, non-haem Fe had lower bioavailability. For Zn, thiamin and vitamin B12, 10–31 % and for vitamin A, 60 % of adults had intakes below the EAR.
Diets with all meat and dairy replaced with plant-based foods lowered environmental impacts by >40 %. Estimated intakes of Zn, thiamin, vitamins A and B12, and probably Ca, were below recommendations. Replacing 30 % was beneficial for SFA, Na, fibre and vitamin D intakes, neutral for other nutrients, while reducing environmental impacts by 14 %.
We have investigated organic light emitting diode (OLED) backside contacting for the enhancement of luminance uniformity as a superior alternative to gridlines. In this approach, the low-conductivity OLED anode is supported by a high-conductivity auxiliary electrode and vertically contacted through via holes. Electrical simulations of large-area OLEDs have predicted that this method allows comparable luminance uniformity while sacrificing significantly less active area compared to the common gridline approach.
The method for fabricating backside contacts is comprised of five steps: (1) Thin-film encapsulation of the OLED, (2) Patterning of the OLED surface with lithography (resist mask defining via hole positions), (3) Via hole formation to the bottom anode by a plasma etching process, (4) Organic residues removal and sidewall insulation. (5) Contacting of the anode with a high-conductivity auxiliary electrode.
Backside-contacted OLEDs processed by organic vapor phase deposition show high luminance uniformity. Scanning electron microscopy pictures and electrical breakthrough measurements confirm efficient sidewall insulation.
Recently, organometal halide perovskite solar cells have passed the threshold of 20 % power conversion efficiency (PCE). While such PCE values of perovskite solar cells are already competitive to those of other photovoltaic technologies, processing of large-area devices is still a challenge. Most of the devices reported in literature are prepared by small-scale solution-based processing techniques (e.g. spin-coating). Perovskite solar cells processed by vacuum thermal evaporation (VTE), which show uniform layers and achieve higher PCE and better reproducibility, have also been presented. Regarding the co-evaporation of the perovskite constituents, this technology suffers from large differences in the thermodynamic characteristics of the two species. While the organic components evaporate instantaneously at room temperature at pressures in the range of 10−6 hPa, significantly higher temperatures are needed for reasonable deposition rates of the metal halide compound. In addition, hybrid vapor phase deposition techniques have been developed employing a carrier gas to deposit the organic compound on the previously solution-processed metal halide compound. Generally, vapor phase processes have proven to be a desirable choice for industrial large-area production. In this work, we present a setup for the direct chemical vapor phase deposition (CVD) of methylammonium lead iodide (MAPbI3) employing nitrogen as carrier gas. X-ray diffraction (XRD) and scanning electron microscopy (SEM) measurements are carried out to investigate the crystal quality and structural properties of the resulting perovskite. By optimizing the deposition parameters, we have produced perovskite films with a deposition rate of 30 nm/h which are comparable to those fabricated by solution processing. Furthermore, the developed CVD process can be easily scaled up to higher deposition rates and larger substrates sizes, thus rendering this technique a promising candidate for manufacturing large-area devices. Moreover, CVD of perovskite solar cells can overcome most of the limitations of liquid processing, e.g. the need for appropriate and orthogonal solvents.
Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes.
Although financing represents a critical component of health system strengthening and also a defining concern of efforts to move towards universal health coverage, many countries lack the tools and capacity to plan effectively for service scale-up. As part of a multi-country collaborative study (the Emerald project), we set out to develop, test and apply a fully integrated health systems resource planning and health impact tool for mental, neurological and substance use (MNS) disorders.
A new module of the existing UN strategic planning OneHealth Tool was developed, which identifies health system resources required to scale-up a range of specified interventions for MNS disorders and also projects expected health gains at the population level. We conducted local capacity-building in its use, as well as stakeholder consultations, then tested and calibrated all model parameters, and applied the tool to three priority mental and neurological disorders (psychosis, depression and epilepsy) in six low- and middle-income countries.
Resource needs for scaling-up mental health services to reach desired coverage goals are substantial compared with the current allocation of resources in the six represented countries but are not large in absolute terms. In four of the Emerald study countries (Ethiopia, India, Nepal and Uganda), the cost of delivering key interventions for psychosis, depression and epilepsy at existing treatment coverage is estimated at US$ 0.06–0.33 per capita of total population per year (in Nigeria and South Africa it is US$ 1.36–1.92). By comparison, the projected cost per capita at target levels of coverage approaches US$ 5 per capita in Nigeria and South Africa, and ranges from US$ 0.14–1.27 in the other four countries. Implementation of such a package of care at target levels of coverage is expected to yield between 291 and 947 healthy life years per one million populations, which represents a substantial health gain for the currently neglected and underserved sub-populations suffering from psychosis, depression and epilepsy.
This newly developed and validated module of OneHealth tool can be used, especially within the context of integrated health planning at the national level, to generate contextualised estimates of the resource needs, costs and health impacts of scaled-up mental health service delivery.
When caring for a loved one with a life-limiting illness, a caregiver's own physical, emotional, and spiritual suffering can be profound. While many interventions focus on physical and emotional well-being, few caregiver interventions address existential and spiritual needs and the meaning that caregivers ascribe to their role. To evaluate the feasibility and acceptability of the process and content of Caregiver Outlook, we employed a manualized chaplain-led intervention to improve well-being by exploring role-related meaning among caregivers of patients with a life-limiting illness.
We conducted a single-arm pre–post pilot evaluation among caregivers of patients with advanced cancer or amyotrophic lateral sclerosis (ALS). Caregivers completed three chaplain-led intervention sessions focusing on (1) a relationship review, (2) forgiveness, and (3) legacy. Outcomes administered at baseline and at 1 and 2 weeks after the intervention included quality of life, anxiety, depression, spiritual well-being, religious coping, caregiver burden, and grief.
The sample (N = 31) included a range of socioeconomic status groups, and the average age was approximately 60 years. A third of them worked full-time. Some 74% of our participants cared for a spouse or partner, and the other quarter of the sample cared for a parent (13%), child (10%), or other close family member (3%). At baseline, participants did not demonstrate clinical threshold levels of anxiety, depression, or other indicators of distress. Outcomes were stable over time. The qualitative results showed the ways in which Caregiver Outlook was assistive: stepping back from day-to-day tasks, the opportunity to process emotions, reflecting on support received, provoking thoughts and emotions between sessions, discussing role changes, stimulating communication with others, and the anonymity of a phone conversation. Both religious and nonreligious participants were pleased with administration of the chaplain intervention.
Significance of results:
The acceptability and feasibility of Caregiver Outlook were demonstrated among caregivers of patients with an advanced illness. Our pilot findings suggest minor modifications to study participant screening, interventionist guidance, and the study measures.
Mankind has existed for 2·5 million years but only in the last 10 000 years have we been exposed to wheat. Wheat was first cultivated in the Fertile Crescent (South Western Asia) with a farming expansion that lasted from about 9000BC to 4000BC. Thus it could be considered that wheat (and gluten) is a novel introduction to man's diet! Prior to 1939 the rationing system had already been devised. This led to an imperative to try to increase agricultural production. Thus it was agreed in 1941 that there was a need to establish a Nutrition Society. The very roots of the society were geared towards necessarily increasing the production of wheat. This goal was achieved and by the end of the 20th century, global wheat output had expanded 5-fold. Perhaps as a result the epidemiology of coeliac disease (CD) or gluten sensitive enteropathy has changed. CD is a state of heightened immunological responsiveness to ingested gluten in genetically susceptible individuals. CD now affects 1 % or more of all adults, for which the treatment is a strict lifelong gluten-free diet. However, there is a growing body of evidence to show that a far greater proportion of individuals without coeliac disease are taking a gluten-free diet of their own volition. This clinical entity has been termed non-coeliac gluten sensitivity (NCGS), although the condition is fraught with complexities due to overlap with other gluten-based constituents that can also trigger similar clinical symptoms. This review will explore the relationship between gluten, the rising prevalence of modern coeliac disease, and the new entity of NCGS along with its associated uncertainties.
Graetz and Nusselt studied heat transfer between a developed laminar fluid flow and a tube at constant wall temperature. Here, we extend the Graetz–Nusselt problem to dense fluid flows with partial wall slip. Its limits correspond to the classical problems for no-slip and no-shear flow. The amount of heat transfer is expressed by the local Nusselt number
, which is defined as the ratio of convective to conductive radial heat transfer. In the thermally developing regime,
scales with the ratio of position
to Graetz number
is the length of the heated or cooled tube section. The Graetz number
corresponds to the ratio of axial advective to radial diffusive heat transport. In the case of no slip, the scaling exponent
. For no-shear flow,
. The results show that for partial slip, where the ratio of slip length
to tube radius
ranges from zero to infinity,
. For partial slip,
is a function of both position and slip length. The developed Nusselt number
transitions from 3.66 to 5.78, the classical limits, when
. A mathematical and physical explanation is provided for the distinct transition points for