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We sought to better understand breast-specific sensuality (BSS) in sexually inactive breast cancer survivors.We conducted an anonymous cross-sectional survey of breast cancer survivors during surveillance appointments from 2014 to 2016. Sexual inactivity was defined as no sexual activity within 4 weeks prior. Categorical data were analyzed using Fisher's exact test. Multiple logistic regression adjusted for age and menopausal status, and Firth's bias correction accommodated sparse data.Of 585 respondents, 546 (93.3%) were between the ages of 40 and 79 years, of whom 285 (48.7%) were sexually inactive. Favorable post-treatment appearance satisfaction was reported by 413 (71.0%) respondents. Sexually inactive respondents were more likely to score discomfort with their partner seeing their chest after surgery compared with sexually active respondents (41 [20.4%] vs. 34 [11.4%]; p = 0.002). Both sexually inactive and active respondents reported that their chest was important in intimacy after surgery but at significantly different rates (117 [44.3%] vs. 217 [72.6%]; p 0.001). Post-surgical appearance satisfaction for sexually inactive respondents was positively associated with level of comfort with partner seeing their chest after surgery (p 0.001) and with rating of a pleasurable caress of the treated breast (p 0.001).Over 40% of sexually inactive respondents reported their chest was important in intimacy after surgery, suggesting that BSS may be a route to intimacy for sexually inactive breast cancer survivors. Post-surgical breast appearance satisfaction significantly correlated with comfort being seen by one's partner and appreciation of a pleasurable breast caress. Optimizing breast cancer surgical aesthetic outcomes may improve survivorship.

Objective:To evaluate the psychometric characteristics of the Cognitive Difficulties Scale (CDS), a 39-item Likert-type self-report instrument that requires a fifth grade reading level. The CDS is a popular instrument that has been shown to predict cognitive decline in older persons.Method:Participants were 512 consecutive outpatient referrals (71% women, mean age 60.6, and education 14.6 years) for a neuropsychological examination in a memory disorders clinic as part of a broader neurodiagnostic workup for cognitive decline. A principal components analysis was followed by a varimax rotation (Kaiser). Factor scores were investigated in relation to multiple internal and external criteria including demographics, Cronbach’s alpha, Digit Span, and Wechsler Memory Scale-IV Logical Memory (LM) and Visual Reproduction (VR), and Minnesota Multiphasic Personality Inventory (MMPI)-2 measures of depression, anxiety, somatic preoccupations, and thought disturbance.Results:Six dimensions of cognitive complaint emerged accounting for 64% of the variance: attention/concentration, praxis, prospective memory, speech problems, memory for people’s names, and temporal orientation. The factors showed good internal consistency (alphas > .850). Correlations with Digit Span, LM, and VR were all nonsignificant. CDS scores were associated with MMPI-2 measures of anxiety, depression, somatic preoccupation, and thought disturbance. Percentiles and T-scores were derived for raw scores on the CDS and its six component subscales.Conclusion:The CDS is a multidimensional measure of subjective cognitive complaints that provides clinicians with a psychometrically sound basis for deriving a profile with six subscale scores. The test has clinical utility and is a potentially useful tool in research involving age-related cognitive changes and meta-cognition.

De-escalation of breast cancer treatment aims to reduce patient and financial toxicity without compromising outcomes. Level I evidence and National Comprehensive Cancer Network guidelines support omission of adjuvant radiation in patients aged70 y with hormone-sensitive, pT1N0M0 invasive breast cancer treated with endocrine therapy. We evaluated radiation use in patients eligible for guideline concordant omission of radiation.Subgroup analysis of patients eligible for radiation omission from two pooled randomized controlled trials, which included stage 0-III breast cancer patients undergoing breast conserving surgery, was performed to evaluate factors associated with radiation use.Of 631 patients, 47 (7.4%) met radiation omission criteria and were treated by 14 surgeons at eight institutions. The mean age was 75.3 (standard deviation + 4.4) y. Majority of patients identified as White (n = 46; 97.9%) and non-Hispanic (n = 44; 93.6%). The mean tumor size was 1.0 cm; 37 patients (88.1%) had ductal, 4 patients (9.5%) had lobular, and 17 patients (40.5%) had low-grade disease. Among patients eligible for radiation omission, 34 (72.3%) patients received adjuvant radiation. Those who received radiation were significantly younger than those who did not (74 y, interquartile range = 4 y, versus 78 y, interquartile range = 11 y, P = 0.03). There was no difference in radiation use based on size (P = 0.4), histology (P = 0.5), grade (P = 0.7), race (P = 1), ethnicity (P = 0.6), institution (P = 0.1), gender of the surgeon (P = 0.7), or surgeon (P = 0.1).Fewer than 10% of patients undergoing breast conservation met criteria for radiation omission. Nearly three-quarters received radiation therapy with younger age being a driver of radiation use, suggesting ample opportunity for de-escalation, particularly among younger eligible patients.

The potential impact of depressive symptoms on neuropsychological test performance has been studied extensively yielding mixed results. Self-report depression inventories have been most often used, without a means to screen participants for response bias. Studies have also neglected to screen participants for incomplete effort in testing. In the present study, 48% of an initial sample of outpatient referrals (N = 247) failed to meet traditional validity criteria. The remaining participants were screened for cerebral pathology and then classified into high and low depressive symptom groups (ns = 46) using the median score on Scale D (Depression) of the MMPI-2. The "high depression" subjects scored over 70 T on the D scale (MN = 80 T). The "low depression" subjects scored below 65 T (MN = 58 T). Age, education, and estimated intelligence were equivalent across groups. Neuropsychological test performances were compared across eight tests: Revised Category Test, Trail Making Test, Part B, Tactual Performance Test (TPT), TPT Memory and Location, Reitan-Indiana Aphasia Screening Test, Seashore Rhythm Test, and the Speech Perception Test. A MANOVA revealed no main effect for group., F(8,69) = 1.05, n.s., and univariate analyses for each test also showed no intergroup differences. The results provide evidence that these neuropsychological tests are appropriately interpreted within a framework of brain-behavior relationships irrespective of an examinee's emotional status.

Purpose: In HER2-positive breast cancer (HER2+BC), neoadjuvant chemotherapy (NACT) with dual HER2-targeted therapy achieves high pathologic complete response (pCR) rates. Anthracycline-free NACT regimens avoid toxicities associated with anthracyclines, but every 3-week TCHP also has substantial side effects. We hypothesized that a weekly regimen might have equivalent efficacy with less toxicity; we also investigated whether poorly responding patients would benefit from switching to AC. Methods:Patients with clinical stage II-III HER2+BC received weekly paclitaxel 80 mg/m2 and carboplatin AUC2 with every 3-week trastuzumab and pertuzumab (wPCbTP), with the option of splitting the pertuzumab loading dose. After 12 weeks, responding patients continued wPCbTP for another 6 weeks, while non-responders switched to AC. Dose modifications and post-op therapy were at investigator discretion. Results:In 30 evaluable patients, the pCR rate was 77% (95% CI 58-90%); 12/14 (86%) in ER-negative and 11/16 (69%) in ER-positive. Only two patients transitioned to AC for non-response, of which one achieved pCR. There were no episodes of febrile neutropenia or grade >3 peripheral neuropathy, though several patients who continued wPCbTP stopped before week 18. Split-dose pertuzumab was associated with less grade >2 diarrhea (40%) than the standard loading dose (60%). Conclusions:pCR rates with our regimen were as high as reported with TCHP with fewer grade >3 toxicities, though diarrhea remains a concern. Too few patients had a suboptimal response to adequately test switching to AC. The wPCbTP regimen should be considered an alternative to TCHP as neoadjuvant therapy for HER2+BC.ClinicalTrials.gov identifier: NCT02789657

In HER2-positive breast cancer (HER2+ BC), neoadjuvant chemotherapy (NACT) with dual HER2-targeted therapy achieves high pathologic complete response (pCR) rates. Anthracycline-free NACT regimens avoid toxicities associated with anthracyclines, but every 3-week TCHP also has substantial side effects. We hypothesized that a weekly regimen might have equivalent efficacy with less toxicity; we also investigated whether poorly responding patients would benefit from switching to AC.Patients with clinical stage II-III HER2+ BC received weekly paclitaxel 80 mg/mIn 30 evaluable patients, the pCR rate was 77% (95% CI 58-90%); 12/14 (86%) in ER-negative and 11/16 (69%) in ER-positive. Only two patients transitioned to AC for non-response, of which one achieved pCR. There were no episodes of febrile neutropenia or grade ≥ 3 peripheral neuropathy, though several patients who continued wPCbTP stopped before week 18. Split-dose pertuzumab was associated with less grade ≥ 2 diarrhea (40%) than the standard loading dose (60%).pCR rates with our regimen were as high as reported with TCHP with fewer grade ≥ 3 toxicities, though diarrhea remains a concern. Too few patients had a suboptimal response to adequately test switching to AC. The wPCbTP regimen should be considered an alternative to TCHP as neoadjuvant therapy for HER2+ BC.ClinicalTrials.gov identifier: NCT02789657.

We report an experimental study of the static magnetization $M(H,T)$ and high-field electron spin resonance (ESR) of polycrystalline ${\text{Mg}}_{2}{\text{Gd}}_{3}{\text{Sb}}_{3}{\text{O}}_{14}$, a representative member of the newly discovered class of the so-called tripod kagome antiferromagnets where the isotropic ${\mathrm{Gd}}^{3+}$ spins $(S=7/2)$ form a two-dimensional kagome spin-frustrated lattice. It follows from the analysis of the low-$T\phantom{\rule{4pt}{0ex}}M(H)$ curves that the ${\mathrm{Gd}}^{3+}$ spins are coupled by a small isotropic antiferromagnetic (AFM) exchange interaction, $|J|\ensuremath{\approx}0.3$ K. The $M(H,T)$ dependences measured down to 0.5 K evidence a long-range AFM order at ${T}_{N}=1.7\phantom{\rule{0.28em}{0ex}}\mathrm{K}$ and its rapid suppression at higher fields, $\ensuremath{\ge}4$ T. ESR spectra measured in fields up to 15 T are analyzed considering possible effects of demagnetizing fields, single-ion anisotropy, and spin-spin correlations. While the demagnetization effects due to a large sample magnetization in high fields and its shape anisotropy become relevant at low temperatures, the broadening of the ESR line commencing already at $T\ensuremath{\lesssim}30\phantom{\rule{0.28em}{0ex}}\mathrm{K}$ may indicate the onset of the spin-spin correlations far above the ordering temperature due to the geometrical spin frustration in this compound.

BACKGROUND We examined the impact of cavity shave margins (CSMs) on margin status in patients with pure ductal carcinoma in situ (DCIS) undergoing partial mastectomy (PM). METHODS One hundred and nine patients from 2 multicenter, randomized controlled trials were identified with pure DCIS (no invasive cancer). Surgeons performed their best PM, with specimen radiography and resection of selective margins per surgeon discretion. Patients were then randomized to have CSM resected or not. A positive margin was defined as

The impact of emotional factors on subjective cognitive complaints and memory test performance has been a topic of extensive research, produced conflicting results. Investigators typically used self-report inventories that lack measures of response bias. Studies have also neglected to use performance validity tests (PVTs) to screen participants for incomplete effort. In the present study, 27% of the original sample of non-litigating outpatient referrals (

High-resolution thermal expansion and magnetostriction measurements were performed on single crystals of $\ensuremath{\alpha}\ensuremath{-}{\mathrm{RuCl}}_{3}$ in magnetic fields applied parallel to the Ru-Ru bonds. The length changes were measured in the direction perpendicular to the honeycomb planes. Our data show clear thermodynamic characteristics for the field-induced phase transition at the critical field ${\ensuremath{\mu}}_{0}{H}_{\mathrm{c}1}=7.8(2)\phantom{\rule{0.16em}{0ex}}\mathrm{T}$ where the antiferromagnetic zigzag order is suppressed. At higher fields, a kink in the magnetostriction coefficient signals an additional transition or crossover around ${\ensuremath{\mu}}_{0}{H}_{\mathrm{c}2}\ensuremath{\approx}11\phantom{\rule{0.16em}{0ex}}\mathrm{T}$. The extracted Gr\"uneisen ratio shows typical hallmarks for quantum criticality near ${H}_{\mathrm{c}1}$ but also displays anomalous behavior above ${H}_{\mathrm{c}1}$. We compare our experimental data with spin-wave calculations employing a minimal Kitaev-Heisenberg model in the semiclassical limit. Most of the salient features are in agreement with each other, however, the peculiar features in the region above ${H}_{\mathrm{c}1}$ cannot be accounted for in our semiclassical modeling and hence suggest a genuine quantum nature. We construct a phase diagram for $\ensuremath{\alpha}\ensuremath{-}{\mathrm{RuCl}}_{3}$ in a magnetic field along the Ru-Ru bonds, displaying a zigzag ordered state below ${H}_{\mathrm{c}1}$, a quantum paramagnetic regime between ${H}_{\mathrm{c}1}$ and ${H}_{\mathrm{c}2}$, and a semiclassical partially polarized state above ${H}_{\mathrm{c}2}$.

We provide a supplemental measure based on the Logical Memory (LM) subtest of the Wechsler Memory Scale - IV (Wechsler, 2008) to assist in distinguishing deficient memory storage from compromised retrieval operations. A 20-item five-option multiple choice delayed recognition test for the LM stories is described, followed by descriptive data based on a normative sample of 273 neuropsychologically normal outpatient referrals to a neuropsychology clinic. The analysis indicated that about 43% to 48% of the neuropsychology referrals exhibited retrieval difficulties and were able to store more information in long-term memory than they were able to retrieve on the delayed free recall trial. The 20-item measure, freely available to qualified clinicians, provides useful information regarding a person's ability to store and access newly acquired information.

12132 Background: Sexual dysfunction is common among breast cancer survivors, but poorly characterized in sexually inactive women. We aim to better understand sexual desire in sexually inactive breast cancer survivors. Methods: We performed a cross-sectional survey of breast cancer survivors between 2014 and 2016. Women with a history of breast cancer were approached at a surveillance visit, offered enrollment, and signed consent. They completed the validated 19-question Female Sexual Function Index (FSFI) survey. The FSFI defines sexual inactivity as no sexual activity in the four weeks prior to survey completion. Fisher’s exact test was used for categorical data analysis. Firth’s bias-reduced logistic regression adjusted for age and menopausal status. Results: Of 585 respondents, 305 (53.1%) were age 40 to 59 and 241 (42.0%) were age 60 to 79 when surveyed. Four hundred and twenty-seven (73.0%) were post-menopausal and 285 (48.7%) were sexually inactive. Sexual inactivity was positively correlated with increasing age (p < 0.001) and not being in a current relationship (p < 0.0001). Four hundred and six (69.4%) respondents underwent lumpectomy and 179 (30.6%) underwent mastectomy with most having reconstruction, n = 129 (72.1%). Neither type of surgery or receipt of chemotherapy, endocrine therapy, or radiation were significantly different for sexually inactive and active respondents after controlling for age and menopausal status. 23.6% of sexually inactive respondents reported sexual desire half the time or more. 32.4% of sexually inactive respondents reported feeling sexual desire “a few times (less than half the time)” (versus 28.8% of sexually active respondents, p = 0.005) and 44% reported feeling sexual desire “almost never or never” (versus 8.0% of sexually active respondents, p < 0.001). 31.7% of sexually inactive respondents rated their degree of sexual desire as “low” (versus 25.0% of sexually active respondents, p = 0.04) and 40.9% rated it as “very low or none at all” (versus 7.0% of sexually active respondents, p < 0.001). 27.5% of sexually inactive respondents experienced moderately high sexual desire. Sexually inactive respondents were more likely to report being dissatisfied with their overall sexual life with 23.5% choosing the rating “moderately dissatisfied” (versus 8.8% of sexually active respondents, p < 0.001) and 28.1% choosing “very dissatisfied” (versus 5.8% of sexually active respondents, p < 0.001). Conclusions: Sexual inactivity is associated with lower rates of self-reported sexual desire and lower satisfaction with overall sexual life. However, nearly a quarter of sexually inactive respondents still reported significant sexual desire. This suggests patients classified as sexually inactive may not be content or indifferent to this lack of sexual activity or desire. Sexual inactivity in breast cancer survivors warrants intervention studies to improve sexual satisfaction.

We report an optimized chemical vapor transport method that enables the growth of FeP single crystals up to 500 mg in mass and $80\phantom{\rule{0.16em}{0ex}}{\mathrm{mm}}^{3}$ in volume. The high quality of the crystals obtained by this method was confirmed by means of energy-dispersive x-ray spectroscopy, high-resolution transmission electron microscopy, low-temperature single-crystal x-ray diffraction, and neutron diffraction experiments. We investigated the transport and magnetic properties of the single crystals, and we calculated the electronic structure of FeP. We show both theoretically and experimentally that the ground state of FeP is metallic. The examination of the magnetic data reveals antiferromagnetic order below ${T}_{\mathrm{N}}=119\phantom{\rule{0.16em}{0ex}}\mathrm{K}$ while transport remains metallic in both the paramagnetic and the antiferromagnetic phase. The analysis of the neutron diffraction data shows an incommensurate magnetic structure with the propagation vector $\mathbf{Q}=(0,0,\ifmmode\pm\else\textpm\fi{}\ensuremath{\delta})$, where \ensuremath{\delta} is close to 0.2. For a full understanding of the magnetic state, further experiments are needed. The successful growth of large high-quality single crystals paves the way for further investigations of itinerant magnets with incommensurate spin structures using a wide range of experimental tools.

Background Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS. Methods The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed. Results Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS. Conclusion In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.

The MMPI-2 and WAIS-IV are commonly used together in neuropsychological evaluations yet little is known about their interrelationships. This study explored the potential influence of psychological factors on WAIS-IV performance in a sample of 180 predominantly male veteran referrals that underwent a comprehensive neuropsychological examination in a VA Medical Center. Exclusionary criteria included failed performance validity testing and self-report distortion on the MMPI-2. A Principal Components Analysis was performed on the 15 MMPI-2 content scales, yielding three broader higher-order psychological dimensions: Internalized Emotional Dysfunction (IED), Externalized Emotional Dysfunction (EED), and Fear. Level of IED was not related to performance on the WAIS-IV Full Scale IQ or its four indexes: (Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed). EED was not related to WAIS-IV performance. Level of Fear, which encompasses health preoccupations (HEA) and distorted perceptions (BIZ), was significantly related to WAIS-IV Full Scale IQ and Verbal Comprehension. These results challenge the common use of high scores on the MMPI-2 IED measures (chiefly depression and anxiety) to explain deficient WAIS-IV performance. In addition, they provide impetus for further investigation of the relation between verbal intelligence and Fear.

Objective Evaluate the psychometric characteristics of the Cognitive Difficulties Scale (CDS; McNair & Kahn, 1983), a 39-item Likert-type self-report instrument that requires a fifth-grade reading level. The CDS is a popular instrument that has been shown to predict cognitive decline. Evaluation included an exploratory factor analysis, measures of internal consistency, relation to demographics, criterion validity, and normative table for raw to T score/percentile transformation. Method Participants were 643 consecutive referrals (71% women, mean age 60.6 and education 14.6 years) for a neuropsychological examination in a memory disorders clinic as part of a broader neurodiagnostic workup for cognitive decline. A principal components analysis was conducted followed by varimax rotation (Kaiser). Factor scores were investigated in relation to multiple internal and external criteria. Results Six dimensions of cognitive complaint emerged accounting for 64% of the variance: Attention/Concentration, Fine Motor Skill, Prospective Memory, Speech Problems, Memory for Names, and Temporal Orientation. Factors showed good internal consistencies (alphas > .850). Correlations with Logical Memory, Visual Reproduction, and Digit Span were all nonsignificant. CDS factor scores were highly predictive of MMPI-2 measures of anxiety, depression, and somatic preoccupation. Percentiles and T-scores were derived for the CDS total score and its six component scales. Conclusion The CDS is a multidimensional measure of subjective cognitive complaints that provides clinicians with a psychometrically sound basis for deriving a profile with six subscale scores. The test has substantial clinical utility, and is a potentially useful tool in exploring subjective cognitive decline as a prodrome to dementia.

Objective We introduce a supplemental measure based on the Logical Memory (LM) subtest of the Wechsler Memory Scale – IV (Wechsler, 2008) to assist in distinguishing deficient memory storage from compromised retrieval operations. A 20-item five-option multiple choice delayed recognition test for the LM stories is described, followed by descriptive data based on a normative sample of 168 female and 105 male neurologically normal outpatient referrals to a neuropsychology clinic. Method Ten 5-option items were developed for each of the three LM stories (A, B, and C) reflecting the stories’ narrative content, yielding 20 items for administration to examinees under 70 (Stories B and C) and older than 69 (Stories A and B). Four distractor options for each item were designed to be “plausible” alternatives for the examinee who had little or no recollection of the narrative material. Examinees (N=360), screened for performance validity (effort), completed the LM Recognition test immediately after delayed LM free recall. Results Internal consistency (Cronbach alpha) was acceptable for both 20-item LM Recognition tests. Individuals’ scaled scores on LM-Recognition were compared with LM-II (free recall). Recognition was superior (> one SD) to free recall performance in 43% (age 18 to 69) and 48.2% (age 70+). Conclusion Delayed free recall scores often underestimate a person’s ability to encode and store new information. For clinical application, separate LM Recognition norms were derived for older (Stories A and B) and younger examinees (stories B and C). This 20-item measure assists clinicians in differentiating between storage and retrieval deficits on the Logical Memory subtest.

Chemistry of materials 31(8), 2795 - 2806 (2019). doi:10.1021/acs.chemmater.8b05017, High-quality single crystals of MnBi2Te4 are grown for the first time by slow cooling within a narrow range between the melting points of Bi$_2$Te$_3$ (586 °C) and MnBi$_2$Te$_4$ (600 °C). Single-crystal X-ray diffraction and electron microscopy reveal ubiquitous antisite defects in both cation sites and, possibly, Mn vacancies (Mn$_{0.85(3)}$Bi$_{2.10(3)}$Te$_4$). Thermochemical studies complemented with high-temperature X-ray diffraction establish a limited high-temperature range of phase stability and metastability at room temperature. Nevertheless, the synthesis of MnBi$_2$Te$_4$ can be scaled-up as powders can be obtained at subsolidus temperatures and quenched at room temperature. Bulk samples exhibit long-range antiferromagnetic ordering below 24 K. The Mn(II) out-of-plane magnetic state is confirmed by the magnetization, X-ray photoemission, X-ray absorption, and linear dichroism measurements. The compound shows a metallic type of resistivity in the range 4.5–300 K and is an n-type conductor that reaches a thermoelectric figure of merit up to ZT = 0.17. Angle-resolved photoemission experiments show a surface state forming a gapped Dirac cone, thus strengthening MnBi$_2$Te$_4$ as a promising candidate for the intrinsic magnetic topological insulator, in accordance with theoretical predictions. The developed synthetic protocols enable further experimental studies of a crossover between magnetic ordering and nontrivial topology in bulk MnBi$_2$Te$_4$., Published by American Chemical Society, Washington, DC

Magnetic topological insulators are narrow-gap semiconductor materials that combine non-trivial band topology and magnetic order. Unlike their nonmagnetic counterparts, magnetic topological insulators may have some of the surfaces gapped, which enables a number of exotic phenomena that have potential applications in spintronics, such as the quantum anomalous Hall effect and chiral Majorana fermions. So far, magnetic topological insulators have only been created by means of doping nonmagnetic topological insulators with 3d transition-metal elements; however, such an approach leads to strongly inhomogeneous magnetic and electronic properties of these materials, restricting the observation of important effects to very low temperatures. An intrinsic magnetic topological insulator—a stoichiometric well ordered magnetic compound—could be an ideal solution to these problems, but no such material has been observed so far. Here we predict by ab initio calculations and further confirm using various experimental techniques the realization of an antiferromagnetic topological insulator in the layered van der Waals compound MnBiTe. The antiferromagnetic ordering that MnBiTe shows makes it invariant with respect to the combination of the time-reversal and primitive-lattice translation symmetries, giving rise to a ℤ topological classification; ℤ = 1 for MnBiTe, confirming its topologically nontrivial nature. Our experiments indicate that the symmetry-breaking (0001) surface of MnBiTe exhibits a large bandgap in the topological surface state. We expect this property to eventually enable the observation of a number of fundamental phenomena, among them quantized magnetoelectric coupling and axion electrodynamics. Other exotic phenomena could become accessible at much higher temperatures than those reached so far, such as the quantum anomalous Hall effect and chiral Majorana fermions., We acknowledge support by the Basque Departamento de Educacion, UPV/EHU (grant number IT-756-13), the Spanish Ministerio de Economia y Competitividad (MINECO grant number FIS2016-75862-P), and the Academic D.I. Mendeleev Fund Program of Tomsk State University (project number 8.1.01.2018). Support from the Saint Petersburg State University grant for scientific investigations (grant ID 40990069), the Russian Science Foundation (grants number 18-12-00062 for part of the photoemission measurements and 18-12-00169 for part of the calculations of topological invariants and tight-binding bandstructure calculations), the Russian Foundation for Basic Research (grant number 18-52-06009), and the Science Development Foundation under the President of the Republic of Azerbaijan (grant number EİF-BGM-4-RFTF-1/2017-21/04/1-M-02) is also acknowledged. M.M.O. acknowledges support by the Diputación Foral de Gipuzkoa (project number 2018-CIEN-000025-01). I.I.K. and A.M.S. acknowledge partial support from the CERIC-ERIC consortium for the stay at the Elettra synchrotron. The ARPES measurements at HiSOR were performed with the approval of the Proposal Assessing Committee (proposal numbers 18AG020, 18BU005). The support of the German Research Foundation (DFG) is acknowledged by A.U.B.W., A.I. and B.B. within Collaborative Research Center 1143 (SFB 1143, project ID 247310070); by A.Z., A.E. and A.I. within Special Priority Program 1666 Topological Insulators; by H.B. and F.R. within Collaborative Research Center 1170; and by A.Z. and A.I. within the ERANET-Chemistry Program (RU 776/15-1). H.B., A.U.B.W., A.A., V.K., B.B., F.R. and A.I. acknowledge financial support from the DFG through the Würzburg-Dresden Cluster of Excellence on Complexity and Topology in Quantum Matter – ct.qmat (EXC 2147, project ID 39085490). A.E. acknowledges support by the OeAD grant numbers HR 07/2018 and PL 03/2018. This work was also supported by the Fundamental Research Program of the State Academies of Sciences, line of research III.23. A.K. was financially supported by KAKENHI number 17H06138 and 18H03683. I.P.R. acknowledges support by the Ministry of Education and Science of the Russian Federation within the framework of the governmental program Megagrants (state task number 3.8895.2017/P220). E.V.C. acknowledges financial support by the Gobierno Vasco-UPV/EHU project (IT1246-19). S.K. acknowledges financial support from an Overseas Postdoctoral Fellowship, SERB-India (OPDF award number SB/OS/PDF-060/2015-16). J.S.-B.acknowledges financial support from the Impuls-und Vernetzungsfonds der Helmholtz-Gemeinschaft under grant number HRSF-0067 (Helmholtz-Russia Joint Research Group). The calculations were performed in Donostia International Physics Center, in the research park of Saint Petersburg State University Computing Center (http://cc.spbu.ru), and at Tomsk State University

Background— The aim of this study is to examine the relationship between time in the therapeutic range (TTR) and clinical outcomes in heart failure patients in sinus rhythm treated with warfarin. Methods and Results— We used data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial to assess the relationship of TTR with the WARCEF primary outcome (ischemic stroke, intracerebral hemorrhage, or death), with death alone, ischemic stroke alone, major hemorrhage alone, and net clinical benefit (primary outcome and major hemorrhage combined). Multivariable Cox models were used to examine how the event risk changed with TTR and to compare the high TTR, low TTR, and aspirin-treated patients, with TTR being treated as a time-dependent covariate. A total of 2217 patients were included in the analyses; among whom 1067 were randomized to warfarin and 1150 were randomized to aspirin. The median (interquartile range) follow-up duration was 3.6 (2.0–5.0) years. Mean (±SD) age was 61±11.3 years, with 80% being men. The mean (±SD) TTR was 57% (±28.5%). Increasing TTR was significantly associated with reduction in primary outcome (adjusted P P =0.001), and improved net clinical benefit (adjusted P P =0.082 for ischemic stroke and adjusted P =0.109 for major hemorrhage). Conclusions— In patients with heart failure in sinus rhythm, increasing TTR is associated with better outcome and improved net clinical benefit. Patients in whom good quality anticoagulation can be achieved may benefit from the use of anticoagulants. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00041938.

We report $^{75}\mathrm{As}$ nuclear magnetic resonance measurements on single crystals of ${\mathrm{RbFe}}_{2}{\mathrm{As}}_{2}$ and ${\mathrm{CsFe}}_{2}{\mathrm{As}}_{2}$. Taking previously reported results for ${\mathrm{KFe}}_{2}{\mathrm{As}}_{2}$ into account, we find that the anisotropic electronic correlations evolve towards a magnetic instability in the $A{\mathrm{Fe}}_{2}{\mathrm{As}}_{2}$ series (with $A=\mathrm{K}$, Rb, Cs). Upon isovalent substitution with larger alkali-metal ions, a drastic enhancement of the anisotropic nuclear spin-lattice relaxation rate and decreasing Knight shift reveal the formation of pronounced spin fluctuations with stripe-type modulation. Furthermore, a decreasing power-law exponent of the nuclear spin-lattice relaxation rate ${(1/{T}_{1})}_{H\ensuremath{\parallel}ab}$, probing the in-plane spin fluctuations, evidences an emergent deviation from Fermi-liquid behavior. All these findings clearly indicate that the expansion of the lattice in the $A{\mathrm{Fe}}_{2}{\mathrm{As}}_{2}$ series tunes the electronic correlations towards a quantum critical point at the transition to a yet unobserved ordered phase.

Chronic wounds are of high socio-economic importance. Accurate and efficient treatment includes the use of outcomes measures in clinical care and in research. To date, consented standards for documentation of chronic wounds, agreements on interpretation of wound outcomes and harmonisation about standardised goal setting in wound treatment are lacking. Objective (1) To establish a national German consensus group for the definition of standards in outcomes measurement of chronic wounds, (2) to agree on recommendations for practice and research based on a continuous decision process, including implementation of the standards. Methods The national consensus group includes delegates from the German scientific medical societies involved in health care for chronic wounds, the national boards on nursing, and the chairs of regional wound networks. Moreover, the roof organisations of the German health insurances, the German ministry of health and further single wound experts were invited. The consensus work is based on a structured decision process. Results The consensus group consists of 58 representatives and co-representatives of 26 societies and organisations. Since 2012, in the regular bi-annual meetings a Delphi-based workflow has been followed starting with standards for documentation and outcomes measurement in patients with leg ulcers. Additionally, web-based decision processes are conducted and the results are presented for finalisation in the face-to-face meetings. The following application areas of particular interests were defined: clinical routine, health services research, clinical research, and health economics. In the meantime, 245 single decisions have been approved. Conclusions Based on a national joint process involving medical societies, nursing groups, German sickness funds and health politics, a continuous decision process on standards for outcomes measurement and interpretation could be established. The Delphi based decision processes showed high levels of participations, thus providing a valid and robust set of standards. First results are in process of approval by the societies.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity (Fake Bad Scale [FBS]) Scale is widely used to assist in determining noncredible symptom reporting, despite a paucity of detailed research regarding its itemmetric characteristics. Originally designed for use in civil litigation, the FBS is often used in a variety of clinical settings. The present study explored its fundamental psychometric characteristics in a sample of 303 patients who were consecutively referred for a comprehensive examination in a Veterans Affairs (VA) neuropsychology clinic. FBS internal consistency (reliability) was .77. Its underlying factor structure consisted of three unitary dimensions (Tiredness/Distractibility, Stomach/Head Discomfort, and Claimed Virtue of Self/Others) accounting for 28.5% of the total variance. The FBS's internal structure showed factoral discordance, as Claimed Virtue was negatively related to most of the FBS and to its somatic complaint components. Scores on this 12-item FBS component reflected a denial of socially undesirable attitudes and behaviors (Antisocial Practices Scale) that is commonly expressed by the 1,138 males in the MMPI-2 normative sample. These 12 items significantly reduced FBS reliability, introducing systematic error variance. In this VA neuropsychological referral setting, scores on the FBS have ambiguous meaning because of its structural discordance.

Recently, the iridate double perovskite ${\mathrm{Sr}}_{2}{\mathrm{YIrO}}_{6}$ has attracted considerable attention due to the report of unexpected magnetism in this ${\mathrm{Ir}}^{5+}$ $(5{d}^{4})$ material, in which according to the ${J}_{\mathrm{eff}}$ model, a nonmagnetic ground state is expected. However, in recent works on polycrystalline samples of the series ${\mathrm{Ba}}_{2\ensuremath{-}x}{\mathrm{Sr}}_{x}{\mathrm{YIrO}}_{6}$ no indication of magnetic transitions have been found. We present a structural, magnetic, and thermodynamic characterization of ${\mathrm{Sr}}_{2}{\mathrm{YIrO}}_{6}$ single crystals, with emphasis on the temperature and magnetic field dependence of the specific heat. As determined by x-ray diffraction, the ${\mathrm{Sr}}_{2}{\mathrm{YIrO}}_{6}$ single crystals have a cubic structure, with space group $Fm\overline{3}m$. In agreement with the expected nonmagnetic ground state of ${\mathrm{Ir}}^{5+}$ $({5d}^{4})$ in ${\mathrm{Sr}}_{2}{\mathrm{YIrO}}_{6}$, no magnetic transition is observed down to 430 mK. Moreover, our results suggest that the low-temperature anomaly observed in the specific heat is not related to the onset of long-range magnetic order. Instead, it is identified as a Schottky anomaly caused by paramagnetic impurities present in the sample, of the order of $n\ensuremath{\sim}0.5(2)%$. These impurities lead to non-negligible spin correlations, which nonetheless, are not associated with long-range magnetic ordering.

The cubic double perovskite Ba$_2$YIrO$_6$ has been investigated by the local probe techniques nuclear magnetic resonance ($^{89}$Y NMR) and muon spin rotation (muSR). Both methods confirm the absence of magnetic long-range order in this compound but find evidence for diluted localized paramagnetic moments. NMR spin-lattice relaxation rate 1/T1 measurements suggest a slowing down of localized spin moments at low temperatures. An increase of the muSR spin-lattice relaxation rate lambda confirms the presence of weak magnetism in Ba$_2$YIrO$_6$ . However, these findings cannot be explained by the recently suggested excitonic type of magnetism. Instead, they point towards tiny amounts of localized paramagnetic spin centers leading to this magnetic response on the background of a simple nonmagnetic ground state of the 5d$^4$ ($J=0)$ electronic configuration of Ir$^{5+}$., Comment: 8 pages, 7 figures

The psychological characteristics of acute traumatic brain injury (TBI) have received limited research focus, despite empirical evidence of their relevance for subsequent psychological adjustment and early therapeutic intervention. This study addressed a wide range of psychological features in 47 individuals who were hospitalized as a result of acute mild TBI (mTBI). Participants were screened from amongst consecutive TBI admissions for moderate to severe brain injury, and for pre-injury neurological, psychiatric, or substance abuse histories. Clinical and content scale scores on the MMPI-2 were explored in relation to patient gender, age, level of education, and extent of cognitive complaints. The results revealed diverse psychosocial problem areas across the sample, the most common of which were somatic and cognitive complaints, compromised insight, and a naively optimistic self-perception. The mediating roles of injury severity and demographic variables are discussed. Clinical implications and specific recommendations are presented.

This study examined fundamental psychometric characteristics of the Symptom Validity Scale-Revised (FBS-r) in a nonforensic sample of 303 neuropsychological referrals. FBS-r had a reliability (internal consistency) of .747 and two higher order factoral dimensions (Somatic Complaints and Optimism/Virtue). FBS-r had a discordant factor structure: Optimism/Virtue (7 items) was negatively related to Somatic Complaints (21 items) and undercut FBS-r measurement consistency (reliability). FBS-r scores, which purportedly reflect symptom exaggeration, are affected by as much as 23 T-score points on test items that are negatively related to symptom reporting. These data suggest that the FBS-r produces ambiguous scores reflecting two underlying dimensions that warrant additional research.

The Fake Bad Scale (FBS; Symptom Validity Scale) has fundamental psychometric flaws, interpretive problems, and potentially adverse societal consequences that are not appreciated by Ben-Porath et al. (Psychological Injury and Law 2(1), 62–85, 2009a, b). The FBS was constructed without due consideration to scientifically based guidelines for scale development (Clark and Watson, Psychological Assessment 7, 309–319, 1995; Jackson, Psychological Review 78, 229–248, 1971; Nunnally 1978; Holden and Troister, Canadian Psychology 50, 120–130, 2009). After almost two decades in existence, its face, content, and construct validity have not been established in the empirical literature. Oft-cited discriminant studies that appear to support the FBS are premature because of the scale’s unestablished psychometric foundation. In addition, these studies have significant methodological weaknesses that preclude definitive conclusions about what the scale actually measures. We review these weaknesses and recent legal cases that challenge the scale. We recommend that the FBS’s validity and fairness be addressed in an independent scientific review by the Buros Mental Measurement Test Evaluation System, a non-profit center specializing in the evaluation of commercially available tests.

Based on a focused review and careful analysis of a large amount of published research, Butcher et al. (Psychol Inj and Law 1(3):191–209, 2008) concluded that the Fake Bad Scale (FBS) does not appear to be a sufficiently reliable or valid measure of the construct “faking bad”. Butcher et al. (Psychol Inj and Law 1(3):191–209, 2008) pointed out examples of errors in some of the most widely cited studies (including meta-analytic) used to support the FBS and described potential biases if the FBS is used to impute the motivation to malinger in those reaching its variable and imprecise cutoff scores. In a response to this article, Ben-Porath et al. (Psychol Inj Law 2:62–85, 2009) dismissed all the concerns raised in it with suggestions that our conclusions were based on faulty premises, misunderstandings of basic concepts, misleading descriptions of Minnesota Multiphasic Personality Inventory (MMPI) research, flawed analyses, and so on. This reply corrects some of Ben-Porath and colleagues’ (Psychol Inj Law 2:62–85, 2009) multiple misrepresentations of the points made in Butcher et al. (Psychol Inj and Law 1(3):191–209, 2008) and identifies eight logical fallacies relevant to the FBS controversy. We end with a challenge to other psychologists to fully examine the underlying FBS research before adopting this scale in their clinical practice.

This proof-of-concept study was performed in order to establish the pharmacokinetics and pharmacodynamics of increasing oral doses of the satiety peptides glucagon-like peptide-1 (GLP-1) and peptide YY3-36 (PYY3-36). Six healthy male subjects were given oral doses of either a placebo or GLP-1 in a dose-escalating schedule (doses of 0.5, 1.0, 2.0, and 4.0 mg). Next, another group of six healthy male subjects were given oral doses of either a placebo or PYY3-36 in the same pattern of escalating doses (doses of 0.25, 0.5, 1.0, 2.0, and 4.0 mg). In healthy male volunteers, (i) oral administration of either of the peptides induced a rapid and dose-dependent increase in plasma drug concentrations; (ii) oral administration of GLP-1 induced a potent effect on insulin release; and (iii) both peptides suppressed ghrelin secretion. In conclusion, this study showed, for the first time, that satiety peptides such as GLP-1 and PYY3-36 can be orally delivered safely and effectively in humans.

The Fake Bad Scale (FBS), developed to identify malingering of emotional distress among claimants seeking compensation for personal injuries, was recently added to the MMPI-2 scoring materials, resulting in its widespread dissemination across the various clinical settings that use the MMPI-2 in psychological evaluations. We examine: (1) questions of item bias in the FBS; (2) how malingering and nonmalingering groups are identified in FBS studies, including whether the research has been broadly inclusive and fully represents the populations assessed by the MMPI-2; (3) the reliability and validity of the FBS; (4) the highly variable recommendations for raw score cut-offs and how they relate to T scores; (5) two inpatient groups [men in a tertiary care Veterans Affairs Healthcare System (VA) unit and women in an eating disorders program] who may be inappropriately labeled as malingering by the FBS; (6) the publisher’s statement on use of the FBS; and (7) a Frye hearing in Florida where the FBS was excluded from expert testimony, one of three so far. We raise questions about its potential bias against people with disabilities and physical illnesses, women, individuals exposed to highly traumatic situations, and those motivated to present themselves in a favorable light. Psychologists using the FBS for making decisions about clients’ motivations need to be aware of the serious problems with the scale’s use and the cases of its inadmissibility in court.

Materials with a $5{d}^{4}$ electronic configuration are generally considered to have a nonmagnetic ground state ($J=0$). Interestingly, ${\mathrm{Sr}}_{2}{\mathrm{YIrO}}_{6}$ (${\mathrm{Ir}}^{5+}$ having $5{d}^{4}$ electronic configuration) was recently reported to exhibit long-range magnetic order at low temperature and the distorted ${\mathrm{IrO}}_{6}$ octahedra were discussed to cause the magnetism in this material. Hence, a comparison of structurally distorted ${\mathrm{Sr}}_{2}{\mathrm{YIrO}}_{6}$ with cubic ${\mathrm{Ba}}_{2}{\mathrm{YIrO}}_{6}$ may shed light on the source of magnetism in such ${\mathrm{Ir}}^{5+}$ materials with $5{d}^{4}$ configuration. Besides, ${\mathrm{Ir}}^{5+}$ materials having $5{d}^{4}$ are also interesting in the context of recently predicted excitonic types of magnetism. Here we report a single-crystal-based analysis of the structural, magnetic, and thermodynamic properties of ${\mathrm{Ba}}_{2}{\mathrm{YIrO}}_{6}$. We observe that in ${\mathrm{Ba}}_{2}{\mathrm{YIrO}}_{6}$ for temperatures down to 0.4 K, long-range magnetic order is absent but at the same time correlated magnetic moments are present. We show that these moments are absent in fully relativistic ab initio band-structure calculations; hence, their origin is presently unclear.

Hintergrund Ziel dieser Studie war es, Hinweise auf die Haufigkeit extrakardialer, v. a. pulmonaler Rechts-links-Shunts (RLS) bei Patienten mit akuter zerebraler Ischamie unklarer Ursache zu erlangen.