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Despite major advancements in surgery and anesthesia, the risk of mortality following cardiac and non-cardiac surgery remains high and is frequently associated with perioperative organ dysfunction. Neurological derangements range from brief postoperative delirium to postoperative cognitive dysfunction to perioperative stroke with associated impact on quality of life and mortality. Major adverse cardiac events and arrhythmias play a significant role in adverse clinical outcomes following all surgical procedures. GI dysfunction represents one of the more common complications following surgery, while hepatic dysfunction remains infrequent but largely uninvestigated. Perioperative endocrine dysfunction consists of both hyperglycemia and hypoglycemia, both of which can have significant effects on perioperative course and recovery. Postoperative pulmonary complications remain one of the more common perioperative complications depending on patient-related and surgical factors. Perioperative acute kidney injury is common in the perioperative setting. This chapter briefly explores the impact of cardiac and non-cardiac surgery on individual organ systems and some of the effects of these perturbations on perioperative morbidity and mortality.
Obesity is highly prevalent and disabling, especially in individuals with severe mental illness including bipolar disorders (BD). The brain is a target organ for both obesity and BD. Yet, we do not understand how cortical brain alterations in BD and obesity interact.
Methods:
We obtained body mass index (BMI) and MRI-derived regional cortical thickness, surface area from 1231 BD and 1601 control individuals from 13 countries within the ENIGMA-BD Working Group. We jointly modeled the statistical effects of BD and BMI on brain structure using mixed effects and tested for interaction and mediation. We also investigated the impact of medications on the BMI-related associations.
Results:
BMI and BD additively impacted the structure of many of the same brain regions. Both BMI and BD were negatively associated with cortical thickness, but not surface area. In most regions the number of jointly used psychiatric medication classes remained associated with lower cortical thickness when controlling for BMI. In a single region, fusiform gyrus, about a third of the negative association between number of jointly used psychiatric medications and cortical thickness was mediated by association between the number of medications and higher BMI.
Conclusions:
We confirmed consistent associations between higher BMI and lower cortical thickness, but not surface area, across the cerebral mantle, in regions which were also associated with BD. Higher BMI in people with BD indicated more pronounced brain alterations. BMI is important for understanding the neuroanatomical changes in BD and the effects of psychiatric medications on the brain.
Patients with obsessive-compulsive disorder (OCD) with the compulsion to wash have fear of contamination or feel contaminated. The compulsion to wash often lasts for hours, so that massive difficulties to cope with everyday life follow. There exist only few data on the aetiology of specific OCD-subgroups as the compulsive disorder to wash. Specific neural correlates of OCD with compulsion to wash have never been analyzed before. Existing neuroimaging data on OCD generally show changes of neural activity in the striatum, orbitofrontal cortex and anterior cingulated gyrus. A dysfunction of frontostriatal loops is supposed as one cause of OCD. From a psychoanalytic point of view OCD with the specific compulsion to wash is related to a suppression of autosexual and aggressive drives.
In our neuroimaging study (fMRI) we compared the neural networks of OCD-patients with the compulsion to wash and healthy controls. We used a picture-paradigm consisting of autosexual, aggressive, disgusting, neutral and water pictures. We were interested in the neural correlates of OCD-patients with compulsion to wash regarding the different affective pictures categories and expected neural differences between patients and controls. Stimuli were taken partly from the IAPS, partly also self- constructed and validated by a control group. First results point at significant differences in neural activity between patients and healthy controls, especially in diseases-related components as autosexual, aggressive and water pictures. OCD-patients used a more extended and more emotional related network of brain structures.
Our study provides new insights into neural correlates of OCD-patients with the compulsion to wash.
Analysis of entire barley (Hordeum vulgare ‘Moravian’) seedlings exposed to triallate [S-(2,3,3-trichloroallyl)-diisopropylthiocarbamate] vapor for 5 days after a 5-day germination period resulted in a linear rate of accumulation of triallate, while wild oat (Avena fatua L.) seedlings accumulated triallate for 1/2 to 2 days after exposure with no net accumulation thereafter. Similar accumulation patterns were shown for a similar exposure period when barley and wild oat were seeded 1.3 cm below a triallate-treated soil layer in the greenhouse. More triallate accumulated in wild oat and barley when they were planted in a triallate-treated soil layer than below. Since barley accumulated greater amounts of triallate without injury than wild oat, differential uptake of triallate was not the reason for selectivity.
The present study sought to identify both the ingredients for success and the potential impediments to social marketing effectiveness for healthy eating behaviour, focusing on studies conducted over the last 10 years.
Design
A comprehensive literature review was undertaken examining seventeen databases to identify studies reporting the use of social marketing to address healthy eating. Thirty-four empirical studies were analysed to examine the effectiveness of social marketing interventions to improve healthy eating behaviour using Andreasen's (2002) social marketing benchmark criteria. Statistical analysis was undertaken to quantitatively evaluate whether effectiveness varied between study categories (subsets).
Setting
Healthy eating empirical studies published from 2000 onwards.
Subjects
Empirical studies that self-identified as social marketing.
Results
Sixteen social marketing studies (subset 1) were identified in the review. These were systematic studies which sought to change behaviour through tailored solutions (e.g. use of marketing tools beyond communication was clearly evident) that delivered value to the target audience. For these sixteen studies, the mean number of criteria identified was five. Six studies met all six criteria. Positive change to healthy eating behaviour was found in fourteen of sixteen studies. The sixteen studies that met the definition of social marketing used significantly more of Andreasen's (2002) criteria and were more effective in achieving behavioural change than the eighteen studies in subset 2.
Conclusions
Social marketing is an involved process and it is important that studies identifying as social marketing adopt social marketing benchmark criteria. Social marketing when employed to its full extent offers the potential to change healthy eating.
Several robotic exploration missions will travel to Mars during this decade to investigate habitability and the possible presence of life. Field research at Mars analogue sites such as desert environments can provide important constraints for instrument calibration, landing site strategies and expected life detection targets. We have characterized the mineralogy, organic chemistry and microbiology of ten selected sample sites from the Utah desert in close vicinity to the Mars Desert Research Station (MDRS) during the EuroGeoMars 2009 campaign (organized by International Lunar Exploration Working Group (ILEWG), NASA Ames and ESA ESTEC). Compared with extremely arid deserts (such as the Atacama), organic and biological materials can be identified in a larger number of samples and subsequently be used to perform correlation studies. Among the important findings of this field research campaign are the diversity in the mineralogical composition of soil samples even when collected in close proximity, the low abundances of detectable polycyclic aromatic hydrocarbons (PAHs) and amino acids and the presence of biota of all three domains of life with significant heterogeneity. An extraordinary variety of putative extremophiles, mainly Bacteria and also Archaea and Eukarya was observed. The dominant factor in measurable bacterial abundance seems to be soil porosity and lower small (clay-sized) particle content. However, correlations between many measured parameters are difficult to establish. Field research conducted during the EuroGeoMars 2009 campaign shows that the geological history and depositional environment of the region, as well as the mineralogy influence the ability to detect compounds such as amino acids and DNA. Clays are known to strongly absorb and bind organic molecules often preventing extraction by even sophisticated laboratory methods. Our results indicate the need for further development and optimization of extraction procedures that release biological compounds from host matrices to enable the effective detection of biomarkers during future sampling campaigns on Earth and Mars.
Stapedotomy produces the best hearing results of any otological operation. However, in a small number of cases the air–bone gap is not successfully closed, or conductive hearing loss recurs.
Objective:
To investigate the proportion of cases in the senior author's series which required revision surgery and to determine the medium to long term success rate of surgery, taking into account the results of revision surgery.
Methods:
Review of a series of 233 primary stapedotomy operations and 100 revision procedures carried out by one surgeon over a 20-year period.
Results:
Closure of the air–bone gap to within 10 dB was achieved in 80 per cent of cases following the primary procedure. Fifteen per cent of patients developed a recurrence of conductive hearing loss. When the results of revision surgery were taken into account, the proportion of ears with a mean air–bone gap of less than 10 dB was 86 per cent. However, of the patients undergoing revision surgery, air–bone gap closure to within 10 dB was only achieved in 52 per cent of cases.
Conclusion:
The best chance of obtaining a successful outcome in stapedotomy is to achieve this for the first procedure. However, revision surgery does increase the medium to long term success rate.
With the advent of intense, coherent light sources in the XUV and soft X-ray regime, X-ray Thomson scattering becomes a unique tool for the diagnostics of dense plasmas. The scattering spectrum gives direct access to plasma properties like density, temperature, and composition. In dense systems, collisions among constituents are of primary importance for the prediction and interpretation of the scattering signal. We present a systematic approach to the dynamical structure factor using the Born-Mermin ansatz to include collisions via the dynamical collision frequency. Calculations of the scattering spectrum are performed for X-ray scattering on solid and compressed beryllium targets as well as for XUV-photons scattering on hydrogen at near solid density.
The potential created by an infinitesimal alternating dipole in a Maxwellian magnetoplasma is computed numerically at the plasma and upper-hybrid resonance frequencies when the latter extends from one to three times the electron cyclotron frequency. A linear full kinetic theory is used for a homogeneous magnetoplasma for which the forced ion motion and the collisions are neglected. The integral which gives the potential is evaluated by using the least-damping- roots (LDR) approximation, i.e. by neglecting the higher-order roots of the dispersion equation for electrostatic waves. Some characteristic potential patterns of dipoles parallel and perpendicular to the magnetic field are computed and comparisons with analytical results previously published are made. The numerical and analytical patterns are similar only at the plasma frequency when the dipole is parallel to the magnetic field.
There is a paucity of evidence to guide the post-operative follow up of patients undergoing middle-ear ventilation tube insertion for the first time. This study was conceived to identify current practice at our institution (Ninewells Hospital, Dundee) and to inform subsequent change in our follow-up procedure.
Methods:
Two cycles of data collection and analysis were performed. All paediatric patients undergoing ventilation tube insertion for the first time were identified. Patients who had previously undergone ventilation tube insertion or additional procedures such as adenoidectomy or tonsillectomy were excluded. The first data collection period comprised all of the year 2000, and the second 18 months over 2003–2004. A minimum of 20 months' follow up was allowed for. Data regarding clinical findings and audiometry were recorded at each follow-up appointment.
Results:
We identified a total of 50 patients meeting our criteria for inclusion in the first cohort. There were a total of 156 appointments between surgery and data collection (a mean of 3.12 per child). A total of 113 (72 per cent) appointments lead to no medical intervention. The only statistically significant difference between patients requiring further ventilation tube insertion (n = 10) and those not requiring further treatment during the study period (n = 40) was the average hearing threshold (p < 0.01). These findings prompted a change in the post-operative regime; all patients undergoing ventilation tube insertion were subsequently seen at three months for a pure tone audiogram, and further review depended on clinical and audiometric findings. Records for 84 children were identified and collected for the second cohort, there were a total of 154 appointments (a mean of 1.83 per child). In only 18 appointments (12 per cent) were normal findings and hearing recorded and children given a further review appointment. Sixteen of 29 (55 per cent) children with abnormal clinical findings (otorrhoea, tube blockage or extrusion) required some form of intervention (p < 0.05). Twenty-six had a mean hearing threshold worse than 20 dB at first review. Nineteen (73 per cent) required further intervention of some sort (p < 0.01).
Conclusions:
Our study demonstrated that the vast majority of review appointments resulted in no clinical intervention. We therefore question the need for regular follow up in this patient group. Twenty per cent (10 of 50 and 18 of 84) of our patients required further ventilation tube insertion within the study periods. This is consistent with rates reported in the literature. Children with abnormal clinical findings or a mean hearing threshold greater than 20 dB were significantly more likely to require further intervention. We would recommend one post-operative review with audiometry, three months after surgery. At this initial appointment, further review should be offered to those children with poor hearing, early extrusion, blockage or infection, as they are more likely to require further ventilation tube insertion. This strategy is dependent on good links with community primary care providers and easy access to secondary care for further management, should this be required.
We present the adaptive optics assisted, near-infrared VLTI instrument GRAVITY for precision narrow-angle astrometry and interferometric phase referenced imaging of faint objects. With its two fibers per telescope beam, its internal wavefront sensors and fringe tracker, and a novel metrology concept, GRAVITY will not only push the sensitivity far beyond what is offered today, but will also advance the astrometric accuracy for UTs to 10 μas. GRAVITY is designed to work with four telescopes, thus providing phase referenced imaging and astrometry for 6 baselines simultaneously. Its unique capabilities and sensitivity will open a new window for the observation of a wide range of objects, and — amongst others — will allow the study of motion within a few times the event horizon size of the Galactic Center black hole.
We describe two patients with stapes fixation, in both of whom Rosen mobilization seemed to be the most prudent surgical choice. In both cases, a useful hearing gain was achieved initially. In the patient with otosclerosis, the conductive hearing loss recurred and a stapedectomy was subsequently carried out. In the patient with congenital stapes fixation, the hearing gain was maintained for two years eight months. We believe that this technique still has a place in stapes surgery in rare instances.
This paper reports on the status of the PHELIX petawatt laser which is
built at the Gesellschaft fuer Schwerionenforschung (GSI) in close
collaboration with the Lawrence Livermore National Laboratory (LLNL), and
the Commissariat à l'Energie Atomique (CEA) in France. First
experiments carried out with the chirped pulse amplification (CPA)
front-end will also be briefly reviewed.
A hierarchy of low-dimensional Galerkin models is proposed for the viscous, incompressible flow around a circular cylinder building on the pioneering works of Stuart (1958), Deane et al. (1991), and Ma & Karniadakis (2002). The empirical Galerkin model is based on an eight-dimensional Karhunen–Loève decomposition of a numerical simulation and incorporates a new ‘shift-mode’ representing the mean-field correction. The inclusion of the shift-mode significantly improves the resolution of the transient dynamics from the onset of vortex shedding to the periodic von Kármán vortex street. In addition, the Reynolds-number dependence of the flow can be described with good accuracy. The inclusion of stability eigenmodes further enhances the accuracy of fluctuation dynamics. Mathematical and physical system reduction approaches lead to invariant-manifold and to mean-field models, respectively. The corresponding two-dimensional dynamical systems are further reduced to the Landau amplitude equation.
Evidence of female preference for dominant males during mating is reported for the rock shrimp Rhynchocinetes typus. Two sexually mature males of different ontogenetic stage were tethered at opposite sides of a large tank. Tethering restricted males from actively pursuing the receptive female but allowed females to choose between males. Surprisingly most (10 out of 11) females first approached the subordinate typus male, but after these initial contacts all females chose the dominant robustus male. Following antennal and corporal contacts of variable duration seven (out of 11) females initiated the mating process with the robustus male, while four females did not initiate mating during the 90 min observation period. The fact that all mating females selected the robustus shows strong female preferences for these males. It is suggested that female preference for large and dominant males is common among crustaceans with sexual size-dimorphism.
We present experimental results on the structure of Ag thin films grown on high-symmetry surfaces of both quasicrystals and approximants. For coverages above ten monolayers, Ag form fcc nanocrystals with (111) plane parallel to the surface plane. Depending on the substrate surface symmetry, the Ag nanocrystals exist in one, two or five different orientations, rotated by a multiple of 2π/30. The orientation relationship between crystalline films and substrates appears to be determined by the following principles: high atomic density rows of the adsorbate are aligned along high atomic density rows of the substrate.
Near-square islands form during sub-monolayer homoepitaxial growth on metal (100) surfaces. Diffusion of these islands after deposition leads to collision of island pairs, typically corner-to-corner creating dumbbell-shaped clusters. Subsequent coalescence (or sintering) recovers a near-square equilibrium shape. This process is mediated by periphery diffusion (PD) and its study can provide detailed insight into the underlying dynamic processes and energetics. Atomistic modeling reveals that the size scaling of the characteristic relaxation time, τ, depends on the detailed energy barriers of various hopping processes that contribute to PD. Simulations without an extra kink or corner rounding barrier for PD reveals τ ∼ L4, while behavior approaching τ ∼ L3 is observed with a significant extra kink rounding barrier for PD. The latter is consistent with experimental observations for Ag/Ag(100) at 300 K.