Food consumption patterns, seasonal dietary diversity, and factors affecting food intake in rural Eastern Uganda: A mixed-methods cross-sectional study.

This mixed-methods cross-sectional study examines food consumption patterns, dietary diversity, and factors affecting food intake and malnutrition in the rural Mbale District in Eastern Uganda, during both wet and dry seasons. Participants (n = 100; 66% females) completed a food frequency questionnaire identifying foods and beverages consumed in the preceding 12 months. Individual interviews (n = 8) were conducted with key workers. Analysis of seventeen food items revealed seasonal variations in carbohydrate and protein sources. During the dry season, staples like matooke (mashed boiled plantains) and sweet and Irish potatoes were affected, while protein-rich foods such as beans and groundnuts saw increased consumption in the wet season. Fruit and vegetable intake also rose during the wet season. The main causes of malnutrition that emerged from the interviews were the lack of knowledge about food and nutrition, financial struggles, climate impact, and cultural beliefs. The last theme covered strategies to combat malnutrition. Although carbohydrate intake remains consistent throughout seasons due to reliance on posho (maize flour porridge) and cassava, variations in the number of meals and protein sources, particularly beans and groundnuts, were observed. Both of these, being the primary protein sources in rural households' diets, are highly susceptible to climate fluctuations. This may pose significant implications for food security, as heightened climate instability may impede their production. Solutions to combat malnutrition discussed by the interviewees include education, employment, family planning, and healthcare improvements. Professionals emphasise the need for comprehensive approaches to address these complex issues. In addition, data on food consumption during the dry and wet seasons should be collected as a difference in food consumption during the seasons may become more prominent with the need to implement tailored interventions.

Custom nasal obturator for velopharyngeal dysfunction: Digitizing the fabrication process.

Nasal obturation using a removable medical device is a suitable treatment option for patients with velopharyngeal dysfunction. In the United Kingdom in recent years, the use of nasal obturation has increased because of the successful collaborations among the Speech and Language Therapy, Restorative Dentistry, and Maxillofacial departments. However, fabrication of the devices requires specialist skill and considerable time. A digital process which facilitates the rapid, cost effective production of a light, comfortable, unobtrusive nasal obturator is described.

AtomAccess: A Predictive Tool for Molecular Design and Its Application to the Targeted Synthesis of Dysprosium Single-Molecule Magnets.

Isolated dysprosocenium cations, [Dy(CpR)2]+ (CpR = substituted cyclopentadienyl), have recently been shown to exhibit superior single-molecule magnet (SMM) properties over closely related complexes with equatorially bound ligands. However, gauging the crossover point at which the CpR substituents are large enough to prevent equatorial ligand binding, but small enough to approach the metal closely and generate strong crystal field splitting has required laborious synthetic optimization. We therefore created the computer program AtomAccess to predict the accessibility of a metal binding site and its ability to accommodate additional ligands. Here, we apply AtomAccess to identify the crossover point for equatorial coordination in [Dy(CpR)2]+ cations in silico and hence predict a cation that is at the cusp of stability without equatorial interactions, viz., [Dy(Cpttt)(Cp*)]+ (Cpttt = C5H2tBu3-1,2,4, Cp* = C5Me5). Upon synthesizing this cation, we found that it crystallizes as either a contact ion-pair, [Dy(Cpttt)(Cp*){Al[OC(CF3)3]4-κ-F}], or separated ion-pair polymorph, [Dy(Cpttt)(Cp*)][Al{OC(CF3)3}4]·C6H6. Upon characterizing these complexes, together with their precursors, yttrium and yttrium-doped analogues, we find that the contact ion-pair shows inferior SMM properties to the separated ion-pair, as expected, due to faster Raman and quantum tunneling of magnetization relaxation processes, while the Orbach region is relatively unaffected. The experimental verification of the predicted crossover point for equatorial coordination in this work tests the limitations of the use of AtomAccess as a predictive tool and also indicates that the application of this type of program shows considerable potential to boost efficiency in exploratory synthetic chemistry.

Characterisation of magnetic relaxation on extremely long timescales.

The use of magnetisation decay measurements to characterise very slow relaxation of the magnetisation in single-molecule magnets is becoming increasingly prevalent as relaxation times move to longer timescales outside of the AC susceptibility range. However, experimental limitations and a poor understanding of the distribution underlying the stretched exponential function, commonly used to model the data, may be leading to misinterpretation of the results. Herein we develop guidelines on the experimental design, data fitting, and analysis required to accurately interpret magnetisation decay measurements. Various measures of the magnetic relaxation rate extracted from magnetisation decay measurements of [Dy(Dtp)2][Al{OC(CF3)3}4] previously characterised by Evans et al., fitted using combinations of fixing or freely fitting different parameters, are compared to those obtained using the innovative square-wave "waveform" technique of Hilgar et al. The waveform technique is comparable to AC susceptometry for measurement of relaxation rates on long timescales. The most reliable measure of the relaxation time for magnetisation decays is found to be the average logarithmic relaxation time, e〈ln[τ]〉, obtained via a fit of the decay trace using a stretched exponential function, where the initial and equilibrium magnetisation are fixed to first measured point and target values respectively. This new definition causes the largest differences to traditional approaches in the presence of large distributions or relaxation rates, with differences up to 50% with ß = 0.45, and hence could have a significant impact on the chemical interpretation of magnetic relaxation rates. A necessary step in progressing towards chemical control of magnetic relaxation is the accurate determination of relaxation times, and such large variations in experimental measures stress the need for consistency in fitting and interpretation of magnetisation decays.

Physical Grounds for Causal Perspectivalism.

We ground the asymmetry of causal relations in the internal physical states of a special kind of open and irreversible physical system, a causal agent. A causal agent is an autonomous physical system, maintained in a steady state, far from thermal equilibrium, with special subsystems: sensors, actuators, and learning machines. Using feedback, the learning machine, driven purely by thermodynamic constraints, changes its internal states to learn probabilistic functional relations inherent in correlations between sensor and actuator records. We argue that these functional relations just are causal relations learned by the agent, and so such causal relations are simply relations between the internal physical states of a causal agent. We show that learning is driven by a thermodynamic principle: the error rate is minimised when the dissipated power is minimised. While the internal states of a causal agent are necessarily stochastic, the learned causal relations are shared by all machines with the same hardware embedded in the same environment. We argue that this dependence of causal relations on such 'hardware' is a novel demonstration of causal perspectivalism.

Opposing effects of spatiotemporal variation in resources and temporal variation in climate on density dependent population growth in seabirds.

Understanding how ecological processes combine to shape population dynamics is crucial in a rapidly changing world. Evidence has been emerging for how fundamental drivers of density dependence in mobile species are related to two differing types of environmental variation-temporal variation in climate, and spatiotemporal variation in food resources. However, to date, tests of these hypotheses have been largely restricted to mid-trophic species in terrestrial environments and thus their general applicability remains unknown. We tested if these same processes can be identified in marine upper trophic level species. We assembled a multi-decadal data set on population abundance of 10 species of colonial seabirds comprising a large component of the UK breeding seabird biomass, and covering diverse phylogenies, life histories and foraging behaviours. We tested for evidence of density dependence in population growth rates using discrete time state-space population models fit to long time-series of observations of abundance at seabird breeding colonies. We then assessed if the strength of density dependence in population growth rates was exacerbated by temporal variation in climate (sea temperature and swell height), and attenuated by spatiotemporal variation in prey resources (productivity and tidal fronts). The majority of species showed patterns consistent with temporal variation in climate acting to strengthen density dependent feedbacks to population growth. However, fewer species showed evidence for a weakening of density dependence with increasing spatiotemporal variation in prey resources. Our findings extend this emerging theory for how different sources of environmental variation may shape the dynamics and regulation of animal populations, demonstrating its role in upper trophic marine species. We show that environmental variation leaves a signal in long-term population dynamics of seabirds with potentially important consequences for their demography and trophic interactions.

A preliminary study of radioulnar wrist compression in improving patient-reported outcomes of carpal tunnel syndrome.

Previous studies have shown radioulnar wrist compression augments carpal arch space. This study investigated the effects of radioulnar wrist compression on patient-reported outcomes associated with carpal tunnel syndrome. Subjects underwent thrice-daily (15 min each time 45 min daily) wrist compression over 4 weeks with an additional four weeks of follow-up without treatment. Primary outcomes included Boston Carpal Tunnel Questionnaire symptom and functional severity scales (SSS and FSS) and symptoms of numbness/tingling based on Visual Analog Scales. Our results showed that radioulnar wrist compression improved SSS by 0.55 points after 2 weeks (p < 0.001) and 0.51 points at 4 weeks (p < 0.006) compared to the baseline scale. At the four-week follow-up, SSS remined improved at 0.47 points (p < 0.05). Symptoms of numbness/tingling improved at two and 4 weeks, as well as the follow-up (p < 0.05). Hand motor impairment such as weakness had a lower frequency across carpal tunnel syndrome sufferers and does not significantly improve (p > 0.05). Radioulnar wrist compression might be an effective alternative treatment in improving sensory related symptoms in patients with mild to moderate carpal tunnel syndrome.

Combined Treatment of Trapeziometacarpal Joint Arthritis and Scapholunate Advanced Collapse Wrist.

PURPOSE: The combined treatment of trapeziometacarpal joint arthritis and scapholunate advanced collapse (SLAC) wrist presents unique challenges. The consequences of the loss of radial column support caused by scaphoidectomy and trapeziectomy are not well known. The purpose of this study was to evaluate the outcomes of the simultaneous and staged treatment of trapeziometacarpal joint arthritis and SLAC wrist. METHODS: A retrospective review of patients who underwent surgery for both trapeziometacarpal joint arthritis and SLAC wrist was performed. The wrist and thumb range of motion; grip and pinch strength; pain; quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; and radiographs were analyzed. RESULTS: Twenty-four patients who underwent both trapeziectomy and 1 of 3 procedures for SLAC wrist (4-corner fusion [n = 10]), proximal row carpectomy [n = 9], and total wrist arthroplasty [n = 5]) in a single stage (n = 10) or in 2 stages (n = 14) were included. The median age was 63 years. The median follow-up period was 35 months. Twelve (50%) patients underwent complete scaphoidectomy, and 12 (50%) patients underwent partial scaphoidectomy. All 3 procedures resulted in an improvement in pain at rest, pain during activity, and quick Disabilities of the Arm, Shoulder and Hand scores. The final range of motion, grip and pinch strength, and complication rates were consistent with those reported in the literature for isolated procedures. CONCLUSIONS: Trapeziometacarpal joint arthritis and SLAC wrist may be treated either simultaneously or in stages. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Triceps tongue versus olecranon osteotomy for intra-articular distal humeral fractures: a matched-cohort study.

BACKGROUND: There are various approaches to the distal humerus when managing a distal humeral fracture, and controversy exists regarding which approach is optimal. The purpose of this study was to report the outcomes of the triceps tongue (TT) approach when used for osteosynthesis of AO type 13-A, B, and C distal humeral fractures. Secondarily, we aimed to compare the outcomes of the TT approach vs. olecranon osteotomy (OO) when used for osteosynthesis of AO type 13-C distal humeral fractures. METHODS: We performed a retrospective review of patients with distal humeral fractures treated with open reduction-internal fixation by either a TT or OO approach between 2007 and 2019 at 2 separate institutions. TT patients with AO type 13-C fractures were matched to OO patients at a 1:1 ratio based on age, sex, and fracture characteristics. Surgical time, intraoperative blood loss, elbow motion, fracture union, complications, and Disabilities of the Arm, Shoulder and Hand scores were compared. RESULTS: A total of 28 patients treated with the TT approach were assessed, and the matched TT and OO cohorts each comprised 15 patients. The TT group showed less blood loss (119.3 mL vs. 268.5 mL, P = .03), had greater maximal flexion (126° vs. 116°, P = .03), and achieved a larger flexion-extension arc (108° vs. 93°, P = .05) than the OO group. In the OO cohort, 27% of patients had complications directly related to the OO, and OO patients had a higher rate of postoperative ulnar nerve neuritis (33% vs. 0%, P = .04). There was no difference in Disabilities of the Arm, Shoulder and Hand score (P = .08), procedure time (P = .2), total number of patients with ≥1 complication (P = .5), difficulty with union (P = .7), or number of patients requiring revision surgery (P = .7). CONCLUSIONS: The TT approach is a safe and effective approach for the treatment of distal humeral fractures. When compared with the OO approach for AO type 13-C fractures, the TT approach did not differ regarding functional outcomes but showed increased range of motion, decreased intraoperative blood loss, and a lower rate of postoperative ulnar nerve neuritis. The TT approach should be considered as a safe and reliable first-line approach for intra-articular distal humeral fractures because it allows adequate visualization of the articular surface, eliminates complications related to osteotomy including delayed union or nonunion and hardware failure or irritation, and allows for easy conversion to total elbow arthroplasty.

The Van Gorder approach for total elbow arthroplasty.

BACKGROUND: Surgical management of the triceps during exposure for total elbow arthroplasty (TEA) is critical to a successful outcome. Previously described techniques include elevating the triceps insertion from one side or leaving the triceps insertion attached and dislocating the joint. Another approach to the elbow, first described in 1933 by Willis Campbell, MD, and subsequently modified by George Van Gorder, MD, involves turning down the triceps tendon without disrupting the triceps insertion. This approach offers complete visualization of the joint and provides excellent exposure for TEA. Only the original report of the technique and a small series of patients using this technique for TEA exist in the literature. The goal of this study was to evaluate outcomes of the Van Gorder approach in a large series of patients undergoing TEA. METHODS: All patients who underwent TEA from 2008 to 2016 were retrospectively reviewed. Only patients who underwent primary TEA performed through the Van Gorder approach with at least 6 months' follow-up were included for analysis. Patients with prior elbow surgery were excluded. Demographic data, indication for surgery, postoperative range of motion, triceps function, and need for additional surgery were recorded. Prospectively collected visual analog scale (VAS) and Global Health Quality of Life scores were also analyzed. RESULTS: A total of 53 patients met inclusion criteria. The mean age was 62 years, 81% were female, and the average follow-up was 30.2 months. The most common surgical indications included inflammatory arthritis (47%), osteoarthritis (24%), and fracture (19%). Postoperatively, average elbow arc of motion was an 8°-137°. There was 1 patient (1.89%) who developed failure of their triceps extension mechanism. A total of 10 patients (19%) underwent additional elbow surgery most commonly for superficial wound complications. Preoperative VAS scores decreased significantly, starting at 3 months postoperatively (6.76 to 3.37, P < .001), and remained constant at the 12- and 24-month postoperative visits. CONCLUSIONS: This is the largest study evaluating the Van Gorder surgical approach to the elbow for primary TEA with an average follow-up of 32 months. Overall rates of triceps failure and reoperation are consistent with other approaches for TEA.

The association between quality care and outcomes for a real-world population of Australian patients diagnosed with pancreatic cancer.

BACKGROUND: This study: (i) assessed compliance with a consensus set of quality indicators (QIs) in pancreatic cancer (PC); and (ii) evaluated the association between compliance with these QIs and survival. METHODS: Four years of data were collected for patients diagnosed with PC. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A multivariable analysis tested the relationship between significant patient and hospital characteristics, patient cluster effects within hospitals and survival. RESULTS: 1061 patients were eligible for this study. Significant association with improved survival were: (i) in the potentially resectable group having adjuvant chemotherapy administered following surgery or a reason documented (HR, 0.29; 95 CI, 0.19-0.46); (ii) in the locally advanced group included having chemotherapy ± chemoradiation, or a reason documented for not undergoing treatment (HR, 0.38; 95 CI, 0.25-0.58); and (iii) in the metastatic disease group included having documented performance status at presentation (HR, 0.65; 95 CI, 0.47-0.89), being seen by an oncologist in the absence of treatment (HR, 0.48; 95 CI, 0.31-0.77), and disease management discussed at a multidisciplinary team meeting (HR, 0.79; 95 CI, 0.64-0.96). CONCLUSION: Capture of a concise data set has enabled quality of care to be assessed.

Spontaneous Decomposition of an Extraordinarily Twisted and Trans-Bent Fully-Phosphanyl-Substituted Digermene to an Unusual GeI Cluster.

Ditetrelenes R2 E=ER2 (E=Si, Ge, Sn, Pb) substituted by multiple N/P/O/S-donor groups are extremely rare due to their propensity to disaggregate into their tetrylene monomers R2 E. We report the synthesis of the first fully phosphanyl-substituted digermene {(Mes)2 P}2 Ge=Ge{P(Mes)2 }2 (3, Mes=2,4,6-Me3 C6 H2 ), which adopts a highly unusual structure in the solid state, that is both strongly trans-bent and highly twisted. Variable-temperature 31 P{1 H} NMR spectroscopy suggests that 3 persists in solution, but is subject to a dynamic equilibrium between two conformations, which have different geometries about the Ge=Ge bond (twisted/non-twisted) due to a difference in the nature of their π-stacking interactions. Compound 3 undergoes unprecedented, spontaneous decomposition in solution to give a unique GeI cluster {(Mes)2 P}4 Ge4 ⋅5 CyMe (7).

f-Block Phospholyl and Arsolyl Chemistry.

The f-block chemistry of phospholyl and arsolyl ligands, heavier p-block analogues of substituted cyclopentadienyls (CpR , C5 R5 ) where one or more CR groups are replaced by P or As atoms, is less developed than for lighter isoelectronic C5 R5 rings. Heterocyclopentadienyl complexes can exhibit properties that complement and contrast with CpR chemistry. Given that there has been renewed interest in phospholyl and arsolyl f-block chemistry in the last two decades, coinciding with a renaissance in f-block solution chemistry, a review of this field is timely. Here, the syntheses of all structurally characterised examples of lanthanide and actinide phospholyl and arsolyl complexes to date are covered, including benzannulated derivatives, and together with group 3 complexes for completeness. The physicochemical properties of these complexes are reviewed, with the intention of motivating further research in this field.

Indomethacin for symptomatic patent ductus arteriosus in preterm infants.

BACKGROUND: Symptomatic patent ductus arteriosus (PDA) is associated with mortality and morbidity in preterm infants. In these infants, prophylactic use of indomethacin, a non-selective cyclooxygenase inhibitor, has demonstrated short-term clinical benefits. The effect of indomethacin in preterm infants with a symptomatic PDA remains unexplored. OBJECTIVES: To determine the effectiveness and safety of indomethacin (given by any route) compared to placebo or no treatment in reducing mortality and morbidity in preterm infants with a symptomatic PDA. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 7), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and Cumulative Index to Nursing and Allied Health Literature (CINAHL), on 31 July 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA: We included RCTs and quasi-RCTs that compared indomethacin (any dose, any route) versus placebo or no treatment in preterm infants. DATA COLLECTION AND ANALYSIS: We used the standard methods of Cochrane Neonatal, with separate evaluation of trial quality and data extraction by at least two review authors. We used the GRADE approach to assess the certainty of evidence for the following outcomes: failure of PDA closure within one week of administration of the first dose of indomethacin; bronchopulmonary dysplasia (BPD) at 28 days' postnatal age and at 36 weeks' postmenstrual age; proportion of infants requiring surgical ligation or transcatheter occlusion; all-cause neonatal mortality; necrotizing enterocolitis (NEC) (≥ Bell stage 2); and mucocutaneous or gastrointestinal bleeding. MAIN RESULTS: We included 14 RCTs (880 preterm infants). Four out of the 14 included studies were judged to have high risk of bias in one or more domains. Indomethacin administration was associated with a large reduction in failure of PDA closure within one week of administration of the first dose (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.23 to 0.38; risk difference (RD) -0.52, 95% CI -0.58 to -0.45; 10 studies, 654 infants; high-certainty evidence). There may be little to no difference in the incidence of BPD (BPD defined as supplemental oxygen need at 28 days' postnatal age: RR 1.45, 95% CI 0.60 to 3.51; 1 study, 55 infants; low-certainty evidence; BPD defined as supplemental oxygen need at 36 weeks' postmenstrual age: RR 0.80, 95% CI 0.41 to 1.55; 1 study, 92 infants; low-certainty evidence) and probably little to no difference in mortality (RR 0.78, 95% CI 0.46 to 1.33; 8 studies, 314 infants; moderate-certainty evidence) with use of indomethacin for symptomatic PDA. No differences were demonstrated in the need for surgical PDA ligation (RR 0.66, 95% CI 0.33 to 1.29; 7 studies, 275 infants; moderate-certainty evidence), in NEC (RR 1.27, 95% CI 0.36 to 4.55; 2 studies, 147 infants; low-certainty evidence), or in mucocutaneous or gastrointestinal bleeding (RR 0.33, 95% CI 0.01 to 7.58; 2 studies, 119 infants; low-certainty evidence) with use of indomethacin compared to placebo or no treatment. Certainty of evidence for BPD, surgical PDA ligation, NEC, and mucocutaneous or gastrointestinal bleeding was downgraded for very serious or serious imprecision. AUTHORS' CONCLUSIONS: High-certainty evidence shows that indomethacin is effective in closing a symptomatic PDA compared to placebo or no treatment in preterm infants. Evidence is insufficient regarding effects of indomethacin on other clinically relevant outcomes and medication-related adverse effects.

Evidence-Based Approach to Timing of Nerve Surgery: A Review.

ABSTRACT: Events causing acute stress to the health care system, such as the COVID-19 pandemic, place clinical decisions under increased scrutiny. The priority and timing of surgical procedures are critically evaluated under these conditions, yet the optimal timing of procedures is a key consideration in any clinical setting. There is currently no single article consolidating a large body of current evidence on timing of nerve surgery. MEDLINE and EMBASE databases were systematically reviewed for clinical data on nerve repair and reconstruction to define the current understanding of timing and other factors affecting outcomes. Special attention was given to sensory, mixed/motor, nerve compression syndromes, and nerve pain. The data presented in this review may assist surgeons in making sound, evidence-based clinical decisions regarding timing of nerve surgery.

Location-dependent change of median nerve mobility in the carpal tunnel of patients with carpal tunnel syndrome.

INTRODUCTION: The purpose of this study was to investigate in vivo median nerve longitudinal mobility in different segments of the carpal tunnel associated with active finger motion in carpal tunnel syndrome (CTS) patients in a comparison with healthy controls. METHODS: Eleven healthy volunteers and 11 CTS patients participated in this study. Dynamic ultrasound images captured location-dependent longitudinal median nerve mobility within the carpal tunnel during finger flexion at the metacarpophalangeal joints using a speckle cross-correlation algorithm. RESULTS: Median nerve longitudinal mobility in the carpal tunnel was significantly smaller in CTS patients (0.0037 ± 0.0011 mm/degree) compared with controls (0.0082 ± 0.0026 mm/degree) (P < .05), especially in the proximal (0.0064 vs 0.0132 mm/degree on average) and middle (0.0033 vs 0.0074 mm/degree on average) carpal tunnel sections. DISCUSSION: Median nerve mobility can potentially serve as a biomechanical marker when diagnosing CTS, or when assessing the effectiveness of surgical and conservative treatments.

P-Ge/Sn π Interactions Versus Arene···Ge/Sn Contacts for the Stabilization of Diphosphatetrylenes, (R2P)2E (E = Ge, Sn).

The diphosphatetrylenes {(Dipp)(R')P}2E [R' = Mes, E = Ge (1Ge), Sn (1Sn); R' = CH(SiMe3)2, E = Sn (2Sn)] have been isolated and characterized by multinuclear and variable temperature NMR spectroscopy and X-ray crystallography [Dipp = 2,6-iPr2C6H3, Mes = 2,4,6-Me3C6H2]. All three compounds crystallize as discrete monomers with two pyramidal phosphorus centers. However, variable-temperature 31P{1H} NMR spectroscopy indicates that both 1Ge and 2Sn are subject to dynamic exchange between this form and a form containing one planar and one pyramidal phosphorus center in solution. In contrast, 1Sn retains two pyramidal phosphorus centers in solution and exhibits no evidence for exchange with a form containing a planar phosphorus center. The related compound [{(Me3Si)2CH}2P]2Sn (3Sn) was isolated in very low yield and was shown by X-ray crystallography to possess one planar and one pyramidal phosphorus center in the solid state. DFT calculations reveal that the conformations of 1Ge, 1Sn, and 2Sn observed in the solid state are significantly stabilized by the delocalization of electron density from the aromatic rings into the vacant p-orbital at the tetrel center. Thus, for diphosphatetrylenes possessing aromatic substituents at phosphorus, stabilization may be achieved by two competing mechanisms: (i) planarization of one phosphorus center and consequent delocalization of the phosphorus lone pair into the vacant tetrel p-orbital or (ii) pyramidalization of both phosphorus centers and delocalization of aromatic π-electron density into the tetrel p-orbital. For 3Sn, which lacks aromatic groups, only the former stabilization mechanism is possible.

The End of a Classical Ontology for Quantum Mechanics?

In this paper, I argue that the Shrapnel-Costa no-go theorem undermines the last remaining viability of the view that the fundamental ontology of quantum mechanics is essentially classical: that is, the view that physical reality is underpinned by objectively real, counterfactually definite, uniquely spatiotemporally defined, local, dynamical entities with determinate valued properties, and where typically 'quantum' behaviour emerges as a function of our own in-principle ignorance of such entities. Call this view Einstein-Bell realism. One can show that the causally symmetric local hidden variable approach to interpreting quantum theory is the most natural interpretation that follows from Einstein-Bell realism, where causal symmetry plays a significant role in circumventing the nonclassical consequences of the traditional no-go theorems. However, Shrapnel and Costa argue that exotic causal structures, such as causal symmetry, are incapable of explaining quantum behaviour as arising as a result of noncontextual ontological properties of the world. This is particularly worrying for Einstein-Bell realism and classical ontology. In the first instance, the obvious consequence of the theorem is a straightforward rejection of Einstein-Bell realism. However, more than this, I argue that, even where there looks to be a possibility of accounting for contextual ontic variables within a causally symmetric framework, the cost of such an account undermines a key advantage of causal symmetry: that accepting causal symmetry is more economical than rejecting a classical ontology. Either way, it looks like we should give up on classical ontology.

Patient-reported outcome measures (PROMs) in pancreatic cancer: a systematic review.

BACKGROUND: The aim of this systematic review is to examine patient-reported outcome measures (PROMs), their attributes and application in patients with pancreatic cancer (PC). METHOD: A systematic literature search was undertaken of articles published to June 2018 to identify PROMs applied in primary studies in PC. Characteristics of the included studies and PROMs were described with identified scales grouped into five domains. The psychometric properties of the identified PROMs were further assessed for reliability and validity among patients with PC. RESULTS: From 1688 studies screened, 170 were included. Almost half (48%) were conducted in patients with unresectable PC; the majority of these (68%) were evaluated in randomized controlled trials. Median questionnaire completion rates fell below 10% of the original cohort within 12 months in patients with unresectable PC compared to 75% in patients with resectable PC. Seventy PROMs were identified, 32 measuring unidimensional parameters (e.g. pain) and 35 measuring multidimensional (e.g. quality of life) constructs. Only five (7%) PROMs were disease-specific and 13 (19%) were validated in patients with PC. Fifty scales were grouped into 19 physical, 9 psychological, 6 psychiatric, 9 social and 7 other domains. CONCLUSION: Three multidimensional PROMs, the: (i) FACT-HEP in unresectable PC; (ii) QLQ-PAN26 (in conjunction with its core QLQ-C30 PROM) in resectable PC; and (iii) MDASI-GI are recommended as instruments to capture quality of life in patients with PC. Summarised scales and psychometric evaluation provide a framework to choose PROMs for scales not captured by the recommended PROMs.

Bis-Monophospholyl Dysprosium Cation Showing Magnetic Hysteresis at 48 K.

Single-molecule magnets (SMMs) have potential applications in high-density data storage, but magnetic relaxation times at elevated temperatures must be increased to make them practically useful. Bis-cyclopentadienyl lanthanide sandwich complexes have emerged as the leading candidates for SMMs that show magnetic memory at liquid nitrogen temperatures, but the relaxation mechanisms mediated by aromatic C5 rings have not been fully established. Here we synthesize a bis-monophospholyl dysprosium SMM [Dy(Dtp)2][Al{OC(CF3)3}4] (1, Dtp = {P(CtBuCMe)2}) by the treatment of in-situ-prepared "[Dy(Dtp)2(C3H5)]" with [HNEt3][Al{OC(CF3)3}4]. SQUID magnetometry reveals that 1 has an effective barrier to magnetization reversal of 1760 K (1223 cm-1) and magnetic hysteresis up to 48 K. Ab initio calculation of the spin dynamics reveals that transitions out of the ground state are slower in 1 than in the first reported dysprosocenium SMM, [Dy(Cpttt)2][B(C6F5)4] (Cpttt = C5H2tBu3-1,2,4); however, relaxation is faster in 1 overall due to the compression of electronic energies and to vibrational modes being brought on-resonance by the chemical and structural changes introduced by the bis-Dtp framework. With the preparation and analysis of 1, we are thus able to further refine our understanding of relaxation processes operating in bis-C5/C4P sandwich lanthanide SMMs, which is the necessary first step toward rationally achieving higher magnetic blocking temperatures in these systems in the future.