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Infrequent, large‐magnitude discharge (>106 m3/s) outburst floods—megafloods—can play a major role in landscape evolution. Prehistoric glacial lake outburst megafloods transported and deposited large boulders (≥4 m), yet few studies consider their potential lasting impact on river processes and form. We use a numerical model, constrained by observed boulder size distributions, to investigate the fluvial response to boulder deposition by megaflooding in the Yarlung‐Siang River, eastern Himalaya. Results show that boulder deposition changes local channel steepness (ksn) up to ∼180% compared to simulations without boulder bars, introducing >100 meter‐scale knickpoints to the channel that can be sustained for >20 kyr. Simulations demonstrate that deposition of boulders in a single megaflood can have a greater influence on ksn than another common source of fluvial boulders: incision‐rate‐dependent delivery of boulders from hillslopes. Through widespread boulder deposition, megafloods leave a lasting legacy of channel disequilibrium that compounds over multiple floods and persists for millennia. Plain Language Summary: Megafloods (discharge equivalent to ≥400 instantaneously draining Olympic‐sized swimming pools per second) can transport a lot of material, including car‐ to house‐sized boulders. Because these boulders are so big, they remain in the channel until the next megaflood or until they weather into smaller pieces. We use a computer model to understand the impact of these megaflood deposited boulders on mountain river processes. We find that megaflood boulders can protect the river from being eroded, causing other processes, like tectonic uplift, to outcompete erosion. Megaflood boulders cause small steps to form within the river. Our modeling shows that these effects can be felt for >20,000 yrs after a single flood. We suggest that megaflood deposition (in addition to erosion) can cause a significant, unique change in mountain river processes. Key Points: We studied channel response to megaflood boulder deposition in the eastern Himalaya using a numerical modelMegaflood boulder deposition locally changes channel steepness up to 180%, creating >100 knickpointsThe compounding effect from multiple megaflood boulder deposits in rapid succession perturbs channel form for many thousands of years [ABSTRACT FROM AUTHOR]

To understand fitness consequences of performance, one must determine how underlying physiological traits result in and constrain performance. Biochemical and mechanistic investment in a performance trait may cause decreased performance elsewhere: a performance tradeoff, indicating performance specialization in a population. (Co)variation exists within individuals, and among individuals, populations, and species. Conflicting patterns of among‐individual and within‐individual covariation may eliminate, or mask, the relationship at the phenotypic level. Multivariate mixed‐effects models (MMMs) model within‐individual and among‐individual variation separately. We used MMMs to test for relationships between physiological and performance traits associated with locomotion in the prairie lizard Sceloporus consobrinus, and tested for tradeoffs at multiple hierarchical levels. We then compared these results to the conventional Pearson correlations. We found a significant among‐individual tradeoff between endurance and climbing speed. Positive covariation within individuals masked the tradeoff at the phenotypic level. Sprint speed positively covaried with climbing speed. Excluding anaerobic scope, which was associated with endurance, no measured physiological traits were predictive of locomotor performance. These data indicate that performance specialization exists among prairie lizards and contribute to a growing body of literature that have successfully used MMMs to uncover performance tradeoffs which may have been masked using conventional methods. [ABSTRACT FROM AUTHOR]

The results of a study of an electromagnetic response and dielectric properties of multicomponent composite materials based on epoxy, ferroelectric BaTiO3 nanoparticles and multiwalled carbon nanotubes for operation in the 0.1–1.1 THz frequency range are presented. The influence of the MWCNT concentration in a ferroelectric composite on its complex permittivity is shown. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the protein expression of DNA mismatch repair (MMR) proteins in patients with cutaneous melanoma (CM) under immune checkpoint inhibitor (ICI) therapy. Methods: Immunohistochemistry was performed on tumor tissue for MMR proteins MLH1, MSH2, MSH6, and PMS2 in 50 metastatic CM patients treated with ICI (ipilimumab, nivolumab, pembrolizumab). Results: Best overall response (BOR) rate was 48% (24/50). Reduced MMR protein expression (nuclear expression in < 80% of tumor cells) was observed in 8 patients (16%). Compared to other clinical parameters, baseline neutrophil/lymphocyte ratio and reduced intratumoral MMR protein expression (P = 0.0033) were determined as the only parameters significantly associated with favorable BOR. However, in this small study population, reduced MMR protein expression did not reach statistical significance in multivariate analysis. Conclusion: Reduced MMR protein expression is observed in CM and might predict favorable BOR in patients treated with ICI, as was observed for other entities. However, these findings need to be substantiated in larger patient cohorts. [ABSTRACT FROM AUTHOR]

This is a qualitative study of written reflection projects by medical learners who completed a clinical rotation in Palliative Care (PC) at an academic tertiary care center. Upon completing their rotation in PC, medical learners were asked to complete an open-ended reflection project that captured their overall impressions of this training and experience. Fourteen reflections were coded and analyzed. Upon analyzing the reflections, 5 main themes emerged. The first theme is that this rotation helped the learners become more empathetic and compassionate towards patients and their families. Second, the learners were able to recognize the humanity in their patients, regardless of their medical condition. Third, each of the learners in this study had meaningful interactions with numerous patients and really felt that they played a supportive and important role in the death of patients with whom they were working. Fourth, this experience challenged the learners to think and act in ways that they have not been taught in medical school. Lastly, the learners experienced a sense of transformation and a new-found appreciation for all of the emotions involved with working with dying patients. Rotating through PC and reflecting upon that experience can be very meaningful for medical learners who have not worked much with dying patients and their families. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the protein expression characteristics of genes employed in a recently introduced prognostic gene expression assay for patients with cutaneous melanoma (CM). Methods: We studied 37 patients with CM and 10 with benign (melanocytic) nevi (BN). Immunohistochemistry of primary tumor tissue was performed for eight proteins: COL6A6, DCD, GBP4, KLHL41, KRT9, PIP, SCGB1D2, SCGB2A2. Results: The protein expression of most markers investigated was relatively low (e.g., DCD, KRT9, SCGB1D2) and predominantly cytoplasmatic in melanocytes and keratinocytes. COL6A6, GBP4, and KLHL41 expression was significantly enhanced in CM when compared to BN. DCD protein expression was significantly correlated with COL6A6, GBP4, and KLHL41. GBP4 was positively correlated with KLHL41 and inversely correlated with SCGB2B2. The latter was also inversely correlated with serum S100B levels at time of initial diagnosis. The presence of SCGB1D2 expression was significantly associated with ulceration of the primary tumor. KRT9 protein expression was significantly more likely found in acral lentiginous melanoma. The presence of DCD expression was less likely associated with superficial spreading melanoma subtype but significantly associated with non-progressive disease. The absence of SCGB2A2 expression was significantly more often observed in patients who did not progress to stage III or IV. Conclusions: The expression levels observed were relatively low but differed in part with those found in BN. Even though we detected some significant correlations between the protein expression levels and clinical parameters (e.g., CM subtype, course of disease), there was no major concordance with the protective or risk-associated functions of the corresponding genes included in a recently introduced prognostic gene expression assay. [ABSTRACT FROM AUTHOR]

Background: Stereotactic body radiotherapy (SBRT) is an established local treatment method for patients with hepatic oligometastasis or oligoprogression. Liver metastases often occur in close proximity to radiosensitive organs at risk (OARs). This limits the possibility to apply sufficiently high doses needed for optimal local control. Online MR-guided radiotherapy (oMRgRT) is expected to hold potential to improve hepatic SBRT by offering superior soft-tissue contrast for enhanced target identification as well as the benefit of gating and daily real-time adaptive treatment. The MAESTRO trial therefore aims to assess the potential advantages of adaptive, gated MR-guided SBRT compared to conventional SBRT at a standard linac using an ITV (internal target volume) approach.Methods: This trial is conducted as a prospective, randomized, three-armed phase II study in 82 patients with hepatic metastases (solid malignant tumor, 1-3 hepatic metastases confirmed by magnetic resonance imaging (MRI), maximum diameter of each metastasis ≤ 5 cm (in case of 3 metastases: sum of diameters ≤ 12 cm), age ≥ 18 years, Karnofsky Performance Score ≥ 60%). If a biologically effective dose (BED) ≥ 100 Gy (α/β = 10 Gy) is feasible based on ITV-based planning, patients will be randomized to either MRgRT or ITV-based SBRT. If a lesion cannot be treated with a BED ≥ 100 Gy, the patient will be treated with MRgRT at the highest possible dose. Primary endpoint is the non-inferiority of MRgRT at the MRIdian Linac® system compared to ITV-based SBRT regarding hepatobiliary and gastrointestinal toxicity CTCAE III or higher. Secondary outcomes investigated are local, locoregional (intrahepatic) and distant tumor control, progression-free survival, overall survival, possible increase of BED using MRgRT if the BED is limited with ITV-based SBRT, treatment-related toxicity, quality of life, dosimetric parameters of radiotherapy plans as well as morphological and functional changes in MRI. Potential prognostic biomarkers will also be evaluated.Discussion: MRgRT is known to be both highly cost- and labor-intensive. The MAESTRO trial aims to provide randomized, higher-level evidence for the dosimetric and possible consecutive clinical benefit of MR-guided, on-table adaptive and gated SBRT for dose escalation in critically located hepatic metastases adjacent to radiosensitive OARs.Trial Registration: The study has been prospectively registered on August 30th, 2021: Clinicaltrials.gov, "Magnetic Resonance-guided Adaptive Stereotactic Body Radiotherapy for Hepatic Metastases (MAESTRO)", NCT05027711. [ABSTRACT FROM AUTHOR]

The damaging effects of solar ultraviolet (UV) radiation exposure to human skin are well known and can reach from accelerated skin aging (photoaging) to skin cancer. Much of the damaging effects of solar UVA (320–400 nm) radiation is associated with the induction of reactive oxygen species (ROS), which are capable to cause oxidative damage to DNA like the oxidized guanosine 8-hydroxy-2' -deoxyguanosine (8-OHdG). Therefore, new UV protective strategies, have to be tested for their efficiency to shield against UV induced damage. We investigated the protective effects of HelioVital sun protection filter foil against UVA1 irradiation in skin cells. It could be shown, that HelioVital sun protection filter foil has protective effects against UVA1 irradiation induced changes in matrix metalloproteinase (MMP) expression. Furthermore a UVA1-dependant regulation of MMP15 in human fibroblasts could be shown for the first time in this context. In addition, this study demonstrated the protective effect of the HelioVital filter film against UVA1-induced ROS production and DNA damage. These results could pave the way for clinical studies with HelioVital filter foil shielding against the damaging effects of phototherapy and other forms of irradiation therapy, thereby increasing the safety and treatment opportunities of these forms of therapy. [ABSTRACT FROM AUTHOR]

Aims: Echinocandin B (ECB) is a kind of lipopeptide antifungal antibiotic, as well as the key precursor of antifungal drug Anidulafungin. Its efficient bioproduction plays an important role in promoting the industrial production of Anidulafungin. Methods and Results: In this study, methyl oleate and Tween 80 were firstly used to enhance the ECB fermentation by Aspergillus nidulans, the results showed that the ECB titre was significantly enhanced with the addition of methyl oleate and Tween 80. Among the lipids, methyl oleate was found to play a pivotal role in increasing the ECB titre to 2123 mg l−1, which was more than five times higher than that of the control. The addition of Tween 80 in the medium resulted in ECB titre increased to 2584 mg l−1. The scanning electron microscope (SEM) and N‐phenyl‐1‐naphthylamine (NPN) assay indicated that Tween 80 could influence the cell membrane permeability of A. nidulans, and enhance the intracellular and extracellular substance exchange, therefore lead to the increasing of ECB titre. Conclusions: Methyl oleate and Tween 80 are optimal carbon sources and surfactants for efficient ECB biosynthesis respectively. Significance and Impact of the Study: Surfactant was used in ECB fermentation for the first time, which provided feasible ideas for optimizing the fermentation process of other fungi. [ABSTRACT FROM AUTHOR]

Summary: Background: Microcystic adnexal carcinoma (MAC) is a rare skin neoplasm that has not been characterized on a molecular basis. Aim: To assess expression profiles of Hedgehog (HH) signalling molecules in MAC and control tumours. Methods: Immunohistochemistry was performed for Sonic Hedgehog (SHH), Indian Hedgehog (IHH), Patched 1 (PTCH1) and Smoothened (SMO) on patient MAC tissue (n = 26) and control tumour tissue, including syringoma (SyG; n = 11), trichoepithelioma (TE; n = 11) and basal cell carcinoma (BCC; n = 12) tissues. Results: Patched 1 and SMO immunoreactivity was significantly higher in BCC than in SyG, TE or MAC (P < 0.001 and P < 0.03, respectively). The highest IHH expression was observed in BCC and TE compared with SyG and MAC (P < 0.04). Notably, the highest SHH protein expression was observed in SyG compared with MAC, TE and even BCC (P < 0.001). In patients with MAC, SMO immunoreactivity significantly (r = 0.51; P < 0.01) correlated with PTCH1 expression. Further correlation studies did not show significant associations between the HH expression markers assessed (P > 0.05). Conclusion: Our results indicate that alterations of the HH signalling are unlikely to play a major role in the pathogenesis of MAC, which is in contrast to the morphologically similar BCC and TE. Our observation provides additional information to the limited molecular pathology knowledge on this rare tumour. [ABSTRACT FROM AUTHOR]

Background: Radiation therapy and chemoradiation therapy play a major role in the definitive management of esophageal cancer. Survival in esophageal cancer patients is still relatively poor, mostly due to high rates of local recurrence and distant metastases. It is hypothesized that dose escalation in radiotherapy could improve outcomes. Therefore, this retrospective analysis aimed to investigate the outcomes and toxicity in patients treated with local dose escalation by means of using simultaneous integrated boost concepts.Methods: Between 2012 and 2018, 101 patients with esophageal carcinoma were analyzed in this monocentric, retrospective study. All patients received definitive chemoradiation or radiation therapy alone as intensity modulated radiotherapy. The prescribed dose was 50.4 Gy in 28 fractions to the primary tumor and the elective lymph nodes as well as a simultaneous integrated boost (SIB) with 58.8 Gy to macroscopic tumor and lymph node metastases. Endpoints were overall survival (OS), progression free survival (PFS), local control rate (LCR) and toxicity.Results: 60 patients (59.4%) received chemoradiation, 41 patients (40.6%) radiotherapy alone. The median follow up was 17 months (range 0-75 months). OS, PFS and LCR were at 63.9%, 53.9% and 59.9% after 1 year and 37.6%, 34.5% and 36.1%, respectively after 3 years. 16 patients (15.8%) in total developed a locoregional recurrence within the field of radiation. In 48 patients (47.5%) at least one grade III° (CTCAE) toxicity was documented during radiotherapy, mostly dysphagia (36 pat., 75%). One patient suffered from a grade IV° pneumonia.Conclusion: This retrospective analysis demonstrates that a SIB concept in definitive (chemo)radiation therapy is safe and feasible, showing acceptable outcomes in this patient cohort. Considering that this cohort mainly consists of elderly patients not eligible for chemotherapy in many cases, we emphasize the aspect of SIB radiation therapy as potential partial compensation for omitted simultaneous chemotherapy. Prospective studies are needed for validation. [ABSTRACT FROM AUTHOR]

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Background: Lefty and Nodal are transforming growth factor β‐related proteins, which, beside their role in determination of laterality during embryogenesis, have also been linked with cancer progression. Objectives: Prompted by the observed significant left‐sided laterality of Merkel cell carcinoma (MCC), we addressed whether Lefty and Nodal are expressed in MCC and correlated expression patterns with clinical parameters such as MCC laterality and patient outcome. Methods: Expression of Lefty and Nodal in primary MCC was assessed in 29 patients by immunohistochemistry. The histology (H‐)score was calculated and correlated with clinical parameters. Results: The median (range) H‐score of Lefty and Nodal was 17.6 (0–291) and 74.9 (0.7–272), respectively. There was a significant correlation between Lefty expression and Nodal expression (correlation coefficient of 0.60, P = 0.0006). There was no significant correlation between Lefty expression and Nodal expression with either tumour laterality, gender, age, Merkel cell polyomavirus status, disease stage, anatomical localization of primary tumours or disease relapse. On univariate analysis, low Lefty expression and Nodal expression were significantly associated with MCC‐specific death (P = 0.010 and P = 0.019, respectively). On univariate analysis, low Lefty expression was the only significant independent predictor for MCC‐specific death (P = 0.025) as indicated by an odds ratio of 14 (95% CI: 1.43–137.33). Conclusions: Lefty and Nodal are frequently expressed in MCC, but not correlated with tumour laterality. Importantly, our data suggest that a low level of Lefty expression in primary MCC is a strong predictor of MCC‐specific death. [ABSTRACT FROM AUTHOR]

There are hundreds of professional and amateur teams throughout the United States that have Native American names (e.g., Chiefs, Redskins, and Blackhawks). Native American symbols, such as arrows, spears, head-dresses, and war paint also continue to feature in the uniforms and branding of many of these teams. Take, for example, the Cleveland Indians who, until 2018, had a caricature of a Native person, referred to as Chief Wahoo, on their hats, jerseys, and batting helmets. This article identifies two opposing sides within the Native mascot debate and uses Social Identity Theory to explain the importance of rituals and symbols in generating a sense of community among sports fans. Social Identity theory provides insights into the reservations that many people have about changing team names, eliminating mascots and rebranding teams. Using data collected at six professional sporting events, this article then tests the efficacy of Social Identity Theory in two ways. The first examines the relationship between respondents' self-reported degree of sports fandom and their view of the Washington Redskins' and Cleveland Indians team imagery. The second examines the relationship between the amount of Redskins and Indians team gear that respondents own and their view of the Washington Redskins' and Cleveland Indians team imagery. [ABSTRACT FROM AUTHOR]

This study provides a preliminary exploration of factors which differentially predict treatment response to telephone-delivered cognitive behavioural therapy (TCBT) compared to face-to-face CBT (CBT) in a randomised non-inferiority controlled trial of 72 children (aged 11–18 years) with obsessive–compulsive disorder (OCD). Potential moderator variables, their interaction with treatment group (CBT, TCBT) and baseline levels of OCD severity were entered into separate regression models where the primary outcome measure was the post-intervention Children's Yale–Brown Obsessive–Compulsive Scale total score (CYBOCS). Separate regressions were also used to test associations between predictors and outcome controlling for pretreatment CYBOCS. Only pretreatment level of parent-rated child peer problems moderated the effects of the two interventions on CYBOCS severity at post-treatment. After controlling for baseline CYBOCS, only family accommodation rated by mothers predicted poorer outcomes in both groups. While CBT and TCBT may be equally effective for adolescents with OCD, the current results tentatively suggest that higher baseline level of peer problems strengthened the response to therapy for youth receiving TCBT and the predictor analyses reinforce the importance of directly addressing family accommodation during CBT for paediatric OCD regardless of delivery mode. Limitations of the current findings and directions for future work are discussed. [ABSTRACT FROM AUTHOR]

Background: Dysregulation of microRNAs (miRNAs) key regulators may contribute to the pathogenesis of malignancies. miRNA machinery genes such Dicer and Drosha have been reported to be biomarkers in different cancer types. Objectives: We aimed to evaluate Drosha and Dicer protein expression in cutaneous T‐cell lymphoma (CTCL). Methods: We performed Drosha and Dicer immunohistochemistry in 45 patients with mycosis fungoides and subtypes. Drosha and Dicer expression scores were correlated with clinical parameters including disease‐specific death (DSD), stage of disease and different laboratory data. Uni‐ and multivariate statistics were performed. Results: On univariate analysis, elevated serum LDH and low Drosha expression were significantly associated with advanced stage (P = 0.032 and 0.0062, respectively) and lymphoma‐specific death (LSD; P = 0.017 and P = 0.005, respectively). Moreover, elevated circulating CD4+/CD26− lymphocytes were significantly associated with advanced stage (P = 0.032) and DSD (P = 0.0098). On multivariate analysis, low Drosha expression remained in the logistic regression model as significant independent predictor for advanced disease stages [P = 0.013; odds ratio: 5 (confidence interval) CI 1.3–19.3]. Moreover, low Drosha expression (P = 0.026) and elevated LDH (P = 0.025) remained as significant independent predictors for DSD with odds ratios of 13.5 (CI 1.3–134.4 and 8.7 CI 1.3–57.2, respectively). Conclusions: Low Drosha expression is an independent predictor for advanced stage as well as LSD in CTCL patients indicating a tumour suppressor gene function of Drosha in this disorder. [ABSTRACT FROM AUTHOR]

Highlights from the article: Abstract: Refractory materials used in aggregates for the thermal processing of biomass and biowaste are attacked by a specific corrosion effect, which is different from when conventional technologies for burning common fuels are used. The fireclay materials STV, ST and special refractory material ARS60N (Figure 2) were resistant to the alkali corrosion tests with the prescribed amount of corrosion agent K SB 2 sb CO SB 3 sb . Resistance to eutectic melts was determined for the STV refractory material, which was fired at various temperatures up to 1400 °C. During laboratory firing at 1100 °C for two 2 h no reaction between refractory material and fly ash was detected (Figure 2). The main requirement for these refractory materials is density, which ensures a minimal infiltration of the refractory material and no penetration of the corrosion agent into the steel part of the furnace.

Summary: Viral infections can be fatal because of the direct cytopathic effects of the virus or the induction of a strong, uncontrolled inflammatory response. Virus and host intrinsic characteristics strongly modulate the outcome of viral infections. Recently we determined the circumstances under which enhanced replication of virus within the lymphoid tissue is beneficial for the outcome of a disease. This enforced viral replication promotes anti‐viral immune activation and, counterintuitively, accelerates virus control. In this review we summarize the mechanisms that contribute to enforced viral replication. Antigen‐presenting cells and CD169+ macrophages exhibit enforced viral replication after infection with the model viruses lymphocytic choriomeningitis virus (LCMV) and vesicular stomatitis virus (VSV). Ubiquitin‐specific peptidase 18 (Usp18), an endogenous type I interferon blocker in CD169+ macrophages, has been identified as a proviral gene, as are B cell activating factor (BAFF) and carcinoembryonic antigen‐related cell adhesion molecule 1 (CEACAM1). Lymphotoxins (LT) strongly enhance viral replication in the spleen and lymph nodes. All these factors modulate splenic architecture and thereby promote the development of CD169+ macrophages. Tumor necrosis factor alpha (TNF‐α) and nuclear factor kappa‐light‐chain‐enhancer of activated B cell signaling (NF‐κB) have been found to promote the survival of infected CD169+ macrophages, thereby similarly promoting enforced viral replication. Association of autoimmune disease with infections is evident from (1) autoimmune phenomena described during a chronic virus infection; (2) onset of autoimmune disease simultaneous to viral infections; and (3) experimental evidence. Involvement of virus infection during onset of type I diabetes is strongly evident. Epstein–Bar virus (EBV) infection was discussed to be involved in the pathogenesis of systemic lupus erythematosus. In conclusion, several mechanisms promote viral replication in secondary lymphatic organs. Identifying such factors in humans is a challenge for future studies. Viral infections can be fatal because of the direct cytopathic effects of the virus or the induction of a strong, uncontrolled inflammatory response. Recently we determined the circumstances under which enhanced replication of virus within the lymphoid tissue is beneficial for the outcome of a disease. This enforced viral replication promotes anti‐viral immune activation and, counterintuitively, accelerates virus control. [ABSTRACT FROM AUTHOR]

Hydroxymethylation studies on cutaneous vascular tumours, such as classic Kaposi sarcoma (CKS) and cutaneous angiosarcoma (CAS), have not been reported yet. As expected, the 5-year sarcoma-specific survival was significantly shorter in CAS patients when compared to CKS patients ( I P i = 0.022). In line with our data, Liu I et al i .9 reported that low 5-hmc or IDH-2 expression alone and combined 5-hmc and IDH-2 expression were associated with lower overall survival rates and higher cumulative tumour recurrence rates in patients with hepatocellular carcinomas. [Extracted from the article]

The article discusses a study conducted on a cohort of Pakistani patients with severe bleeding abnormalities including hematoma, epistaxis and prolonged wound bleeding, who were diagnosed with Bernard‐Soulier syndrome. According to the author, this disease is caused by defects to the platelet receptor for von Willebrand factor (VWF) and is accompanied by low platelet counts and impaired platelet agglutination after stimulation with ristocetin.

Background Tonsillitis is a common condition with an incidence in UK general practice of 37 per 1000 population a year.1 Recurrent tonsillitis results in significant morbidity and impacts on individuals' quality of life. This study assesses the morbidity and quality of life of adults with recurrent tonsillitis, and the impact of surgical intervention on their health state. Objectives To describe disease-specific and global quality of life for adults with recurrent tonsillitis 6 months after tonsillectomy, using two instruments: the health impact of throat problems ( HITP) and EuroQol-visual analogue scale questionnaire. To assess the overall health benefit from tonsillectomy as an intervention using the Glasgow Benefit Inventory ( GBI). To assess potential predictors of tonsillectomy benefit. Design A prospective, observational cohort audit of patients who have fulfilled Scottish Intercollegiate Guideline Network ( SIGN) criteria for tonsillectomy.2 Setting Secondary care, teaching hospital. Participants Seventy patients (57 female), median age 20 years (range 13-41). Results Median preoperative HITP was 47 (range 15-67), compared to 4 (0-72), ( P<.001) 6 months following surgery. Median HITP difference was 39.5 (range −20 to 75). There was no significant change in global Quality of Life. Median overall 6 months GBI was 39 (−3 to 100). Patients had an average of 27 episodes of tonsillitis over a period of seven years before 'achieving' tonsillectomy, significantly higher than the SIGN guidelines of three or more episodes over three years. Conclusions Recurrent tonsillitis causes a poor disease-specific quality of life. Patients experienced a median of three episodes per year for seven years before tonsillectomy. Following tonsillectomy, patients had a significant improvement in their disease-specific quality of life. Baseline HITP significantly improved after tonsillectomy. The results imply patients with recurrent acute tonsillitis may be experiencing undue delay [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Behavioural Family Therapy (BFT) has been shown to help people with some severe mental health conditions, such as schizophrenia, by reducing relapse rates and stress within families., It can be difficult to put family interventions, like BFT, into clinical practice., Families where someone has an intellectual disability can experience more stress compared to those who do not, but we know very little about using BFT with families where a member has an intellectual disability., What this paper adds to existing knowledge? We interviewed nine Community Learning Disability Nurses and Allied Health Professionals about their experiences delivering BFT to families where one member has an intellectual disability. We found that therapists' experiences of delivering BFT were broadly positive, although they found some aspects of their service frustrating., Explain the importance of the paper's findings for a non-specialist audience The study identifies the perceived benefits of BFT as a model to work with families, where a member has an intellectual disability., The study highlights some of the challenges experienced by practitioners, notably issues with engagement and some issues specific to working with adults with an intellectual disability., The findings suggest that it needs to be clear which families would benefit most from BFT, that interventions need to be adapted for people with intellectual disabilities and that Community Learning Disability Nurses and Allied Health Professionals should have support from management to deliver these interventions., Abstract Introduction Studies have found family interventions ( FIs) to be effective in reducing stress and relapse rates for a variety of mental health conditions. However, implementing FIs into clinical practice is challenging. Studies have suggested that levels of stress within some families of people with intellectual disabilities can be high. However, there is little reported about the use and implementation of FIs, such as Behavioural Family Therapy ( BFT), in adult intellectual disability services. Purpose of study To explore the experiences of practitioners delivering BFT to adults with intellectual disabilities. Method A qualitative methodology was employed, using semi-structured individual interviews with BFT therapists from a health professional background ( n = 9). Data were analysed thematically. Results Two overarching themes were identified: positivity and frustration. Discussion Implementation of therapy was identified as being broadly successful but with some underlying challenges, notably wider organizational issues and some issues specific to working with adults with intellectual disabilities. Implications for practice The broadly positive experiences reported provide encouragement for the delivery of FIs, such as BFT, to adults with intellectual disabilities, by professions outwith psychology. However, there is a need to provide clarity on referral processes, adapt materials accordingly for this client group and ensure that supportive management and supervision is available to therapists. [ABSTRACT FROM AUTHOR]

A letter to the editor commenting on reticulate pigmentary disorders including the rare autosomal dominant Dowling-Degos disease (DDD) and Galli-Galli disease is presented.

This work focuses on a polymer based capacitive harvester which can be fabricated with help of roll-to-roll and low cost printing methods. In contrast to electrostatic MEMS based parallel plate transducers or dielectric elastomer systems here, the capacitance is varied as function of the mechanical load by changing of the top electrode area with help of an electrically conducting composite elastomer. In case of a composite elastomer electrode the maximum capacitance in compressed state does not only depend on the thickness and permitivity of the dielectric but first of all on the quality of the interface and the micro structure of the conducting phase in the composite electrode at the interface which was investigated by FEM Maxwell simulation. An equivalent circuit model is used to study the influence of the leakage current inside the dielectric and the bulk resistivity of the elastomer electrode. First experiments with state of the art polymer, thin film and novel printed dielectrics in contact with elastomer electrodes have been performed to prove the harvesting principle at low frequencies. Charges between 25 and 70 nAs per cm2 have been transferred per cycle at 100 V/200 V while the maximum capacity was between 0.4 and 0.8 nF/cm2. [ABSTRACT FROM AUTHOR]

The article a case of a 5-month-old boy with skin blistering. Topics discussed include a single nucleotide polymorphism (SNP) alters mRNA splicing and modulates the phenotype in a patient with two additional mutations leading to premature termination codons (PTC) and dystrophic epidermolysis bullosa (EB) as a heritable skin fragility disorder.

Background: The aim of this study was to assess cardiac function in vascular surgery patients with known coronary artery disease (CAD) who received continuous perioperative beta blocker therapy with esmolol alone versus esmolol in combination with the phosphodiesterase (PDE) III inhibitor enoximone.Patients and Methods: Over a period of 24 h, 28 patients were assigned to receive heart rate (HR) control by continuous infusion of esmolol in combination with the PDE III inhibitor enoximone (Esmolol+Enoximone group) or esmolol alone (Esmolol group; n=14). Cardiac function was assessed by the use of a pulmonary artery catheter and serial measurements of plasma troponin T (TnT) und B-type natriuretic peptide (BNP).Results: The heart rate significantly decreased to the target rate of 50-60 min(-1) in both groups over the observation period. Cardiac index increased significantly only in Esmolol+Enoximone-treated patients (from 2.4+/-0.2 lxmin(-1)xm(-2) to 3.1+/-0.1 lxmin(-1)xm(-2)) and was significantly higher than in the esmolol alone group (from 2.5+/-0.2 lxmin(-1)xm(-2) to 2.4+/-0.1 lxmin(-1)xm(-2)). No patient had detectable levels of cTnT perioperatively. Peak plasma BNP concentrations were significantly increased in both groups but the highest values were measured in the esmolol alone group.Conclusion: Inotropic therapy with the PDE III inhibitor enoximone improves cardiac function in high risk patients with known CAD undergoing vascular surgery and also when receiving systematic heart rate control by continuous infusion of esmolol. [ABSTRACT FROM AUTHOR]